Deutsche medizinische Wochenschrift
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The surgical treatment of peripheral arterial occlusive disease focuses not only on the direct restoration of the femoral bifurcation but also on the peripheral bypass, especially in the case of chronic amputation-threatening ischemia. Comprehensive imaging is indispensable for planning surgical therapy. The local reconstruction of the femoral bifurcation offers very good long-term results and can be easily combined with endovascular methods. ⋯ The technical limit for a bypass system lies in the pedal arteries and their branches. These methods can be combined with upstream and downstream endovascular interventions in the form of a hybrid intervention. Surgical and endovascular interventions are to be considered as complementary.
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Today, peripheral artery disease (PAD) is treated with the most modern endovascular and open surgical revascularisation procedures. But the short and long-term success of these interventions is decisively determined by the conservative therapy of PAD, which therefore represents the absolute basic therapy of every PAD. ⋯ This paper presents the spectrum of both drug and non-drug strategies and focuses on aspects such as platelet inhibition and anticoagulation regimes, lipid-lowering options as well as the benefits and necessity of exercise programs to promote collaterals and improve quality of life by extending the pain-free walking distance. Proven strategies to overcome smoking addiction, use and purpose of vasoactive substances are highlighted as well as the potential risks of diabetic foot syndrome for limb salvage and prevention of wounds.
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Dtsch. Med. Wochenschr. · Oct 2023
[Advanced care planing and end of life decisions - the geriatricians' view].
Medical progress and the increasing desire for self-determination, even in the most difficult life situations, as well as the associated increasing possibilities of influencing life and dying lead to possibilities but also obligations for individual treatment design. Especially at the end of life, the desire for provision is great and many decisions need to be made in advance or by proxy. In daily dealings with sick or seriously ill people at the end of their lives, it is very helpful if appropriate advance directives have been made and the patient's wishes can be implemented simply and clearly. With the possibility of advance planning for the end of life (Advance Care Planning (ACP)), there is a precautionary and planning concept that will hopefully be used more and more in the future.
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Dtsch. Med. Wochenschr. · Oct 2023
[Provision planning at the end of life from a legal point of view].
In the event of the loss of the ability to give consent and thus the possibility of legally validating one's own will, the law regularly provides for a mandatory third-party representation for the patient. However, their design can be influenced preventively, for which purpose those affected are given three options. These options are: patient's decree, health Power of Attorney, guardianship order. ⋯ The written form of the advance directives forms an objective basis for mutual control of future decision-makers in the event of questions of interpretation. Absolute certainty that the current will of the patient corresponds to the future and that it is reliably determined and implemented in the decision-making situation is not possible. Nevertheless, the task is to come as close as possible to this ideal image in clinical reality.