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In the past ten years, there have been significant advances in the
diagnosis and therapy of arterial vascular disease. While long-term
morbidity can only be improved by changing the patient's life-style
and removing any risk factors that may be present(hypertension,
hyperlipidemia, obesity, diabetesmellitus, nicotine abuse),
symptomatic relief may be obtained by various procedures. Besides
conservative treatment of arterial occlusive disease (physical
therapy, medical treatment) and surgical vascular interventions
(thromboendarterectomy, bypass procedures), balloon catheters
introduced percutaneously under local anesthesia have found
increased application in virtually all areas for the dilatation and
recanalization of obstructive lesions in the past few years. The
technique of balloon dilatation, as introduced by Griintzig as a
further development of the percutaneous interventions by Dotter and
Judkins, is no longer the decisive issue. The main objective of
present clinical research is to de termine the proper indications
and patient selection for this procedure, which has found its place
between conservative treatment and surgery. The contents of this
Symposium should provide some guidelines for the indi cations and
postprocedural therapy for the referring physician, the
angiologist, and for the radiologist and cardiologist performing
the dilatation. We owe our thanks to all the specialists involved,
who have provided us with the benefits of their experience. Mrs. H.
Beilmann and Dr. M. Wojtowycz con tributed substantially to the
preparation of the text. I would like to thank them and the staff
of Springer-Verlag for their conscientious work in the interest of
composition and publication quality."
The number of patients with occlusive peripheral vascular disease
of the lower ex- tremities is still growing as rapidly as the
number of patients with coronary heart disease and cerebrovascular
disease. Due to the increase in average life expectancy during the
last few decades, more patients now need surgical vascular
reconstruc- tion. This actually means a demand for more centers
specializing in vascular surgery and equipped with intensive care
facilities, since the number of patients with cardio- vascular and
bronchopulmonary complications is increasing as well. In addition,
the number of patients needing repeated vascular surgery has been
growing. Therefore, the search for simple procedures to recanalize
the arterial lumen which could be performed under local anesthesia
is no surprise. Unfortunately peripheral vascular disease is still
frequently treated by amputations. In 1967, the fIrst report in
German on percutaneous recanalization of arteries with thrombotic
occlusions and stenoses appeared in Rontgenfortschritte. The meth-
od described in this report had been published by Dotter and
Judkins in 1964. Today, 10 years after their report, more data have
been systematically collected on this method in Europe than in the
United States, where it was developed. Possibly an explanation of
this state of affairs is that nonsurgical treatment is favored more
in Europe than in the United States. The scientifIcally based
angiology established by Ratschow served as the foun- dation for
the development of diagnostic work-up and therapy in other
directions beyond the questions of operability and surgical
results.
Dieses Buch dient der Standortbestimmung der verschiedenen
Verfahren, die durch ausgewiesene Experten der verschiedenen
Fachgebiete aktuell und in ubersichtlicher Form dargestellt werden.
Dabei folgt einem Kapitel der interventionellen Kardiologie jeweils
ein entsprechendes Kapitel der interventionellen Angiologie bzw.
Radiologie, wodurch die enge Verwandtschaft, aber auch die
Unterschiede leicht erkennbar werden. Ziel der Herausgeber ist es,
zum einen die interdisziplinare Diskussion anzuregen und zum
anderen die Kenntnisse ausserhalb des eigenen Bereiches bei
gleicher Indikation zu vertiefen. Entsprechend wendet sich das Buch
gleichermassen an die interventionell tatigen Kollegen der
unterschiedlichen Fachrichtungen wie auch an den Allgemeinmediziner
oder Internisten, der die Weichen fur eine erfolgreiche
Weiterbehandlung seines Patienten stellen muss.
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