[Current status of endovascular therapy in the femoropopliteal vascular segment in chronic peripheral arterial occlusive disease].
Technical success of endovascular measures in the femoropopliteal region has increased since the introduction of new technology (hydrophilic guide-wires, stents, stent grafts) in the last decade to rates of more than 90%. If the initial revascularization--even of long segment occlusions--is successful, the modern armamentarium of interventional radiology enables to keep the vessel open acutely. Evidence, that the immediate success of revascularization leads to a continuous improvement of the clinical symptoms, measured by clinically relevant end points (e.g. improvement of walking distance, increase of limb salvage, increase of survival), has yet to be shown. Several prospective randomized trials demonstrated improvement of walking distance after one year follow-up, but not after two years follow-up in patients with chronic femoropopliteal obstructions, who were treated with PTA compared to walking exercise only. The only two prospective randomized trials comparing vascular surgery and endovascular therapy for femoropopliteal obstructions could not demonstrate any advantage of one of the two modalities in patients with claudication or critical ischemia. The transatlantic consensus document (TASC) recommends PTA as therapy of choice in the femoropopliteal arteries only for single stenosis < 3 cm and does not recommend primary stenting. In order to evaluate endovascular therapy in the femoropopliteal region outcome studies are needed, which carefully assess clinically relevant end points like improvement of walking distance, limb salvage, and survival, but also disease specific quality of life evaluations. Several meta-analyses, performed in recent years, have demonstrated that endovascular therapy has a definite role in the femoropopliteal segment. However, the particular role has to be evaluated for the individual clinical case in the light of case-specific findings and symptoms.
Wagner
H J
HJ
Klinik für Strahlenheilkunde, Charité, Campus Virchow-Klinikum, Humboldt Universität zu Berlin. hans-joachim.wagner@charite.de
D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D011150:Popliteal Artery; D016032:Randomized Controlled Trials as Topic