Zur chirurgischen Behandlung der peripheren arteriellen Verschlusskrankheit in Deutschland

Objective: The vascular surgery patient population was defined in a pilot study in terms of the stages of peripheral arterial occlusive disease (PAOD), the frequency of treatment methods and the results. Preoperative risk factors, perioperative morbidity and mortality of endovascular (ER) and open revascularization (OR) were analyzed. Method: A total of nine vascular departments prospectively included all patients treated for POAD in a 3-month period. A simply constructed questionnaire was used that was recorded in the database SurveyMonkey. Results: Data entry took an average of 5 min per patient. In total, 1030 patients were included, 478 with intermittent claudication (IC) and 552 with critical limb ischemia (CLI). Of the patients 121 (11.7 %) were treated exclusively conservatively, primary major amputations were performed in 2.3 % of cases and primary minor amputations in 3.6 %, all for CLI. The ER amounted to 58.9 % and OR to 41.1 % of all procedures in IC. In patients with CLI, the therapy of choice was ER in 47.3 % and OR in 52.7 %. The mean age of the patients was 67.7 years (IC) and 72.6 years (CLI), respectively, 34 % of IC patients were women and 40 % in the CLI group. Patients with IC had less complications than patients with CLI; furthermore, complications were always higher when OR was performed instead of ER (patients without complications in IC: ER 94.7 %, OR 79.5 % and for CLI: ER 80.5 %, OR 60.8 %). No patient with IC died during hospitalization. In the CLI group, hospital mortality was 1.6 % (ER) and 3.9 % (OR), respectively. Conclusion: Postoperative morbidity and mortality were dependent on the PAOD stage and there were more complications with CLI compared with IC. Better results were obtained after ER than after OR; however, the absence of randomization and risk stratification does not allow conclusions to be drawn about the effectiveness of both methods. The questionnaire used in this pilot study enabled the collection of all important data described in larger series in the literature on postoperative morbidity and mortality in PAOD patients, with relatively little effort. It is therefore advisable to extend the pilot project to a substantially larger number of hospitals.