For the surgical treatment of peripheral arterial disease

Die chirurgische Therapie der peripheren arteriellen Verschlusserkrankung konzentriert sich neben der direkten Wiederherstellung der Femoralisbifurkation auf die periphere Bypassanlage, vor allem bei der chronischen amputationsbedrohenden Ischamie. Diese Methoden konnen mit vor- und nachgeschalteten endovaskularen Eingriffen in Form eines Hybrideingriffs kombiniert werden. Operative und endovaskulare Eingriffe sind als komplementar zu betrachten. Abstract The surgical treatment of peripheral arterial occlusive disease focuses not only on the direct restoration of the femoral bifurcation but also on the peripheral bypass, especially in the case of chronic amputation-threatening ischemia. Comprehensive imaging is indispensable for planning surgical therapy. The local reconstruction of the femoral bifurcation offers very good long-term results and can be easily combined with endovascular methods. The peripheral bypass is the central pillar of surgical therapy, especially in CLTI. Autologous vein should always be the first-choice material. It delivers good long-term results in every position. Prosthetic material is only used if there is no vein and should be combined with autologous veins in the crural and pedal area if possible. The technical limit for a bypass system lies in the pedal arteries and their branches. These methods can be combined with upstream and downstream endovascular interventions in the form of a hybrid intervention. Surgical and endovascular interventions are to be considered as complementary.