AINS Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Thieme Verlag Heft 2-2024, Jahrgang 59) ISSN 1439-1074 Seite(n) 114 bis 121 DOI: 10.1055/a-2250-8816 CareLit-Dokument-Nr: 318600 |
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Der unmittelbare und langfristige Erfolg endovaskulärer und offen chirurgischer Revaskularisierungsverfahren wird entscheidend von der konservativen Therapie der pAVK bestimmt. Die „schonende, bewahrende“ Behandlung soll dabei als absolute Basistherapie verstanden werden, weil sie die „Big Five“ der Atherosklerose-Risikofaktoren adressiert. Dieser Beitrag präsentiert das Spektrum sowohl medikamentöser als auch nicht medikamentöser Strategien. Abstract The immediate and long-term success of endovascular and surgical revascularization crucially depends on the conservative treatment of the PAD. The „gentle, preserving“ treatment should be understood as he absolutely basic therapy for every PAD patient, because conservative treatment adresses the „big five“ of atherosclerotic risk factors. This article presents both the full spectrum of pharmacological and non-pharmacological strategies. Kernaussagen Die konservative Therapie ist bei jedem pAVK-Patienten indiziert, egal, ob als alleinstehende Option oder als Basistherapie interventioneller Verfahren. Kurz- und langfristige Effekte endovaskulärer und chirurgischer Revaskularisationsverfahren hängen entscheidend von einem suffizienten Risikofaktoren-Management ab, das die „Big Five“ der Atherosklerose adressiert. Die Komplexität der Risikofaktoren, die Koinzidenz mortalitätsbestimmender Erkrankungen sowie das breite Spektrum der medikamentösen Optionen machen die Angiologie zum zentralen internistischen Ansprechpartner für pAVK-Patienten. Strukturierte Rehabilitationsmaßnahmen und die Integration psychosozialer Belange sind essenziell für Erhalt und Wiederherstellung der Lebensqualität Betroffener. Schlüsselwörter Gehtraining - Thrombozytenaggregationshemmer - Lipidsenker - Raucherentwöhnung Keywords walking training - platelet aggregation inhibitors - lipid-lowering drugs - smoking cessation Received: 31 May 2023 Accepted: 10 July 2023 14 February 2024 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Literatur 1 Rammos C, Steinmetz M, Lortz J. et al. Peripheral artery disease in Germany (2009–2018): Prevalence, frequency of specialized ambulatory care and use of guideline-recommended therapy – A populationbased study. Lancet Reg Health Eur 2021; 5: 100113 DOI: 10.1016/j.lanepe.2021.100113. (PMID: 34557822) Google Scholar 2 Gebauer K, Wintersohl K, Kraska R. et al. Medikamentöse Sekundärprävention bei Patienten mit peripherer arterieller Verschlusskrankheit: Eine sekundärdatenbasierte Analyse [Medication-based secondary prevention in patients with peripheral arterial occlusive disease: An analysis based on secondary data]. Herz 2021; 46 (Suppl. 02) 280-286 Google Scholar 3 Willems LH, Maas DPMSM, Kramers K. et al. Antithrombotic Therapy for Symptomatic Peripheral Arterial Disease: A Systematic Review and Network Meta-Analysis. Drugs 2022; 82: 1287-1302 DOI: 10.1007/s40265-022-01756-6. Google Scholar 4 Aboyans V, Bauersachs R, Mazzolai L. et al. Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy. Eur Heart J 2021; 42 (39) 4013-4024 DOI: 10.1093/eurheartj/ehab390. Google Scholar 5 Masson W, Lobo M, Barbagelata L. et al. Effects of lipid-lowering therapy on major adverse limb events in patients with peripheral arterial disease: A meta-analysis of randomized clinical trials. Vascular 2022; 30 (06) 1134-1141 DOI: 10.1177/17085381211043952. Google Scholar 6 Aboyans V, Ricco JB, Bartelink MEL. et al. ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39 (09) 763-816 DOI: 10.1093/eurheartj/ehx095. Google Scholar 7 Nissen SE, Lincoff AM, Brennan D. et al. CLEAR Outcomes Investigators. Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients. N Engl J Med 2023; 388 (15) 1353-1364 DOI: 10.1056/NEJMoa2215024. Google Scholar 8 Kim BK, Hong SJ, Lee YJ. et al. RACING investigators. Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial. Lancet 2022; 400: 380-390 Google Scholar 9 Frank U, Nikol S, Belch J. et al. ESVM Guideline on peripheral arterial disease. Vasa 2019; 48 (Suppl. 102) 1-79 DOI: 10.1024/0301-1526/a000834. (PMID: 31789115) Google Scholar 10 Lipp HP. Auswahl von Statinen vor dem Hintergrund neu verfasster Lipidleitlinien. Arzneimitteltherapie 2020; 38 (04) 117-124 Google Scholar 11 Laufs U, Weingärtner O, Kassner U. et al. State of the Art: Therapie mit Statinen [State of the Art: Statin Therapy]. Dtsch Med Wochenschr 2022; 147: 62-68 DOI: 10.1055/a-1516-2471. Google Scholar 12 Schwaab B, Bjarnason-Wehrens B, Meng K. et al. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2. J Clin Med 2021; 10 (14) 3071 DOI: 10.3390/jcm10143071. Google Scholar 13 Raspe M, Bals R, Bölükbas S. et al. Smoking cessation in hospitalised patients – Initiate among inpatients, continue when outpatients – A Position Paper by the German Respiratory Society (DGP) Taskforce for Smoking Cessation. Pneumologie 2023; 7 (06) 341-349 DOI: 10.1055/a-2071-8900. Google Scholar 14 S3-Leitlinie Rauchen und Tabakabhängigkeit: Screening, Diagnostik und Behandlung. AWMF-Register Nr. 076–006. Stand: 2021. Google Scholar 15 Livingstone-Banks J, Fanshawe TR, Thomas KH. et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2023; 5 (05) CD006103 DOI: 10.1002/14651858.CD006103.pub8. (PMID: 37142273) Google Scholar 16 Krabbe B, Espinola-Klein C, Malyar N. et al. DGA-German Society of Angiology Board; ESVM-European Society of Vascular Medicine Board. Health effects of e-cigarettes and their use for smoking cessation from a vascular perspective. Vasa 2023; 52 (02) 81-85 DOI: 10.1024/0301-1526/a001056. Google Scholar 17 Wan H, Huang T, Yang P. et al. Efficacy and Safety of Cilostazol for Atherosclerosis: A Meta-analysis of Randomized Controlled Trials. J Cardiovasc Pharmacol 2022; 79 (03) 390 DOI: 10.1097/FJC.0000000000001195. (PMID: 35255053) Google Scholar 18 Desai K, Han B, Kuziez L. et al. Literature review and meta-analysis of the efficacy of cilostazol on limb salvage rates after infrainguinal endovascular and open revascularization. J Vasc Surg 2021; 73 (02) 711-721.e3 DOI: 10.1016/j.jvs.2020.08.125. Google Scholar 19 Keller K, Schmitt VH, Vosseler M. et al. Diabetes Mellitus and its impact on patientprofile and in-hospital outcomes in peripheral artery disease. J Clin Med 2021; 10: 5033 DOI: 10.3390/jcm10215033. (PMID: 34768552) Google Scholar 20 Paul SK, Bhatt DL, Montvida O. The association of amputations and peripheral artery disease in patients with type 2 diabetes mellitus receiving sodium-glucose cotransporter type-2 inhibitors: real-world study. Eur Heart J 2021; 42 (18) 1728-1738 DOI: 10.1093/eurheartj/ehaa956. (PMID: 33289789) Google Scholar 21 Liu G, Li Y, Pan A. et al. Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 Diabetes. JAMA Netw Open 2023; 6 (01) e2252239 DOI: 10.1001/jamanetworkopen.2022.52239. Google Scholar 22 Levin MG, Klarin D, Walker VM. et al. Million Veteran Program. Association Between Genetic Variation in Blood Pressure and Increased Lifetime Risk of Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2021; 41 (06) 2027-2034 DOI: 10.1161/ATVBAHA.120.315482. Google Scholar 23 Venermo M, Sprynger M, Desormais I. et al. Follow-up of patients after revascularisation for peripheral arterial diseases: a consensus document from the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery. Eur J Prev Cardiol 2019; 26 (18) 1971-1984 DOI: 10.1177/2047487319846999. Google Scholar 24 Smolderen KG, Samaan Z, Ward-Zimmerman B. et al. Integrating Psychosocial Care in the Management of Patients With Vascular Disease. J Am Coll Cardiol 2023; 81 (12) 1201-1204 DOI: 10.1016/j.jacc.2023.01.025. Google Scholar 25 Jukema JW, Szarek M, Zijlstra LE. et al. Alirocumab in patients with polyvascular disease and recent acute coronary syndrome: ODYSSEY OUTCOMES Trial. J Am Coll Cardiol 2019; 74: 1167-1176 Google Scholar 26 Ray KK, Troquay RPT, Visseren FLJ. et al. Long-term efficacy and safety of inclisiran in patients with high cardiovascular risk and elevated LDL cholesterol (ORION-3): results from the 4-year open-label extension of the ORION-1 trial. Lancet Diabetes Endocrinol 2023; 11 (02) 109-119 DOI: 10.1016/S2213-8587(22)00353-9. Google Scholar 27 Wood FA, Howard JP, Finegold JA. et al. N-of-1 trial of a statin, placebo, or no treatment to assess side effects. N Eng J of Med 2020; 383 (22) 2182-2184 Google Scholar 28 Herrett E, Williamson E, Brack K. et al. Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials. BMJ 2021; 372: n135 Google Scholar 29 Bytyçi I, Penson PE, Mikhailidis DP. et al. Prevalence of statin intolerance: a meta-analysis. Eur Heart J 2022; 43 (34) 3213-3223 Google Scholar 30 Ghouse J, Isaksen JL, Skov MW. et al. Effect of diabetes duration on the relationship between glycaemic control and risk of death in older adults with type 2 diabetes. Diabetes Obes Metab 2020; 22 (02) 231-242 DOI: 10.1111/dom.13891. Google Scholar 31 Neal B, Perkovic V, Mahaffrey KW. et al. Canagliflozin and Cardiovascular and Renal Events in type 2 Diabetes. N Engl J Med 2017; 377: 644-657 Google Scholar
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