[Treatment strategies in arterial occlusive diseases]

The risk factors predominating in patients with peripheral arterial occlusive disease are cigarette smoking and diabetes. Moreover, hypertension and hyperlipidemia play an important role. Especially younger patients profit from elimination or treatment (primary or secondary prevention), whereas in elderly patients these measures are no longer crucial. In patients with intermittent claudication, the quality of life may be improved by physical training, vasoactive medicaments, optimal management of concomitant diseases and the different modalities of catheter therapy. According to the special situation in critical ischemia, surgical or catheter revascularization is preferred. If these two techniques cannot be used, intra-arterial or intravenous prostanoids are still promising. Aspirin and in second priority ticlopidine are suited for secondary prevention of arteriosclerosis not only in the extracranial, but also in the peripheral vascular region. After endarterectomy and catheter therapy, aspirin improves the long-term outcome by reducing the incidence of restenoses. Better results are obtained by oral anticoagulation in patients with emboli and after local thrombolysis.