[Peripheral arterial occlusive disease--acute intervention and after-care]

Acute ischemia in peripheral arterial occlusive disease due to progressive atherosclerosis is most commonly caused by thrombotic or thromboembolic events. Such a condition is a threat to both the limb and the life of a patient which requires rapid therapeutic decisions based on close cooperation between vascular surgeons, angiologists and radiologists. In complete ischemia with sensomotoric deficit and in suprainguinal occlusions surgical management remains the treatment of choice. Patients with incomplete ischemia and infrainguinal occlusions and patients unfit for major vascular surgery are appropriate candidates for local thrombolysis and percutaneous revascularization procedures. Available data on the main thrombolytic agents fail to show convincing difference between these drugs with regard to their efficacy and safety. Full heparinization is recommended before any definite therapy, after thrombolysis and if necessary after percutaneous transluminal angioplasty (PTA). Antiplatelet drugs should be given before and after reconstructive surgery and PTA and following heparinization after thrombolysis and PTA. In all conditions long-term treatment with antiplatelet drugs is recommended.