「血管内手術の現状と今後の展望」 末梢動脈閉塞，頸動脈に対する血管内手術

Abstract

In the last decade, the therapeutic strategy for patients with peripheral arterial disease (PAD) has changed markedly after the introduction of endovascular treatment and surgical approaches. In particular, endovascular treatment of iliac occlusive disease is an established treatment modality, although the treatment of infrainguinal lesions remains controversial. The trans-Atlantic Inter-Society Consensus II (TASCII) document of 2007 recommended endovascular treatment in patients with TASCII types A and B lesions and surgical bypass in patients with TASCII types C and D lesions. Most patients with critical limb ischemia (CLI) are in poor general condition, and the goal of revascularization in CLI is not only limb salvage but preservation of life. Currently, bypass surgery is the optimal revascularization procedure for bypass-applicable CLI patients. Improvements in endovascular treatment and expansion of its indication may apply especially to CLI patients who are in poor general condition. Carotid disease is an important cause of stroke and may cause 10-20% of all ischemic strokes. The choice of revascularization strategy in tese cases should be based on the surgical risk profile of the patient and the institution′s expertise. Carotid artery stenting is particularly beneficial for patients at high surgical risk, e.g. surgically inaccessible lesions, radiation-induced carotid stenosis, prior ipsilateral radical neck dissection, and prior carotid endarterectomy. Results of medical treatment continue to improve, but there is still the need for more experience which will aid in establishing treatment strategies for severe carotid disease.