[Modern conservative therapy of arterial occlusive diseases]

Therapy of chronic arterial occlusive disease requires an appropriate life style of the patient, including nicotine abstinence, a diet low in fat and calories and physical exercise. Additionally, he must know rules of preventing necroses and must avoid situations leading to an increased demand or to a diminished offer of blood. The medical conservative treatment is stage-dependent and usually comprises numerous therapeutic procedures. The elimination of risk factors must begin in healthy individuals; once involved, it serves only as a prophylaxis of progression. With catheter treatment (Dotter technique) it is possible to open occlusions of large vessels and to dilate stenoses. Administration of streptokinase can dissolve arterial thrombosis even after a rather long period of time (late lysis). The development of collateral vessels can be promoted by decreasing the peripheral vascular resistance behind the arterial occlusion with active muscular training, intraarterial infusions of adenosine triphosphate and with drugs leading to reduction of blood viscosity. Some vasoactive substances may obviously improve aerobic energy metabolism in the tissue. Finally, in patients with rapid progressive disease long-term therapy with anticoagulants or antiplatelet drugs is indicated.