The fate of ischemic limbs in patients with Buerger’s disease based on our 30-year experience: does smoking have a definitive impact on the late loss of limbs?

Sugimoto, Masayuki; Miyachi, Hideaki; Morimae, Hirofumi; Kodama, Akio; Narita, Hiroshi; Banno, Hiroshi; Yamamoto, Kazuhito; Komori, Kimihiro

doi:10.1007/s00595-014-0904-6

Cited by 25 publications

(20 citation statements)

References 12 publications

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“…Moreover, the retrospective analysis of our series of CLI in Buerger's disease implied that smoking had no effect on Buerger's disease once complete remission has been achieved. 18 In comparison with ASO, this distinctive pathophysiology also results in the relatively favorable outcomes for affected limbs.…”

Section: Features Of Buerger's Diseasementioning

confidence: 99%

Endarteritis Obliterans in the Pathogenesis of Buerger’s Disease From the Pathological and Immunohistochemical Points of View

Kobayashi

Sugimoto

Komori

2014

Circ J

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Section: Features Of Buerger's Diseasementioning

confidence: 99%

Endarteritis Obliterans in the Pathogenesis of Buerger’s Disease From the Pathological and Immunohistochemical Points of View

Kobayashi

Sugimoto

Komori

2014

Circ J

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“…Bypass to the tibial arteries was performed in 23 limbs, with assisted primary patency rates of 67.0 % and 45.6 % at fi ve and 10 years. Surprisingly he did not report a signifi cant diff erence in the late limb salvage rate, indicating that once healing of the lesions is achieved the clinical situation may remain stable despite bypass occlusion with preservation of a functional limb [21]. Encouraging results were reported for surgical treatment of large tissue defects combining distal bypasses with free tissue transfers to cover the local defect at the foot [22][23][24].…”

Section: Discussionmentioning

confidence: 85%

Very distal vein bypass in patients with thromboangiitis obliterans

Neufang

Vargas-Gomez

Ewald

et al. 2017

Vasa

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Summary:Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex fi ndings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin confi guration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superfi cial femoral artery was used for infl ow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identifi ed graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after defi nitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.Keywords: Thromboangiitis obliterans, bypass, limb salvage, human, vascular patency ease frequently involves the small distal arteries of the calf and the foot with complete obliteration of the vessel lumen and absence of a suitable distal artery for bypass. The angiographic pattern of TAO is characterized by occlusions of the tibial and pedal arteries and the presence of typical corkscrew collaterals with normal proximal arteries [2,3]. Surgical revascularization with autologous vein bypass is rarely regarded as feasible due to the absence of healthy distal arterial segments or because of the small calibre of patent arteries and recent advances in conservative treatment. Superfi cial veins may become aff ected by the disease in form of phlebitis migrans with consecutive infl ammatory changes [4]. Hence previous infl ammation of the superfi cial veins often limits their availability as bypass grafts. However surgical vein bypass was recommended by Asian groups and a few European groups as an eff ective therapy for critical ischaemia [5][6][7][8][9]. The results of a contemporar...

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“…200,213 According to questionnaire surveys by the MHLW Group Conference, 8.8% resulted in major limb amputation, and 16.7-20.5% of the patients required toe amputation. 208,214 Patients who need revascularization of the upper limb are few. While some patients require finger amputation, very few patients need major amputation of the upper limb.…”

Section: Prognosis ▋ 81 Prognosis Of Ischemic Limbsmentioning

confidence: 99%

JCS 2017 Guideline on Management of Vasculitis Syndrome　― Digest Version ―

Isobe

Amano

Arimura

et al. 2020

Circ J

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AAV ANCA-associated vasculitis ACR American College of Rheumatology ADA adalimumab ANCA anti-neutrophil cytoplasmic antibody AZA azathioprine bDMARDs biologic disease-modifying anti-rheumatic drugs c-ANCA cytoplasmic ANCA CG cryoglobulin CHCC Chapel Hill Consensus Conference Cr creatinine CT computed tomography CRP C-reactive protein CyA cyclosporine CV cryoglobulinemic vasculitis CY cyclophosphamide DMARDs disease-modifying anti-rheumatic drugs * a The aorta and its primary branches corresond to the aorta (ascending, arch, thoracic descending, abdominal descending), primary branches of the aorta (including the coronary artery), and pulmonary artery. * b Multiple lesions are defined as those that involve two or more of the above arteries or sites or two or more segments of the aorta. * c Hypertrophic lesions are detected by ultrasonography (macaroni sign of the common carotid artery), contrast-enhanced CT, contrastenhanced MRI (circumferential contrast enhancement of the arterial wall), and PET-CT (circumferential FDG uptake of the arterial wall). * d Stenotic lesions and dilated lesions are detected by chest radiography (wave-like deformation of the descending aorta), CT angiography, MR angiography, echocardiography (aortic insufficiency), and angiography. They are accompanied by dilatation of the ascending aorta and frequently also by aortic insufficiency. In the chronic stage, circumferential calcification of the arterial wall is visualized by CT, and the development of collateral circulation is detected by CT angiography and MR angiography Points of attention in imaging diagnosis: Contrast-enhanced CT is performed in the late phase of contrast enhancement. CT angiography is performed in the early phase of contrast enhancement with 3-dimensional image processing. Angiography is usually performed when other procedures such as endovascular treatment and coronary artery angiography or left ventriculography are simultaneously intended. C. Conditions to be included in the differential diagnoses of Takayasu arteritis Arteriosclerosis, congenital vascular anomaly, inflammatory abdominal aortic aneurysm, infectious aneurysm, syphilitic mesaortitis, giant cell arteritis (temporal arteritis), vascular Behçet's disease, IgG4-related diseases. Definite: At least 1 of the items in A + any of the conditions in B are observed, and conditions in C can be excluded.

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The fate of ischemic limbs in patients with Buerger’s disease based on our 30-year experience: does smoking have a definitive impact on the late loss of limbs?

Abstract: This study demonstrated no significant difference in the limb salvage rate between ex-smokers and smokers. Our results do not support any advantageous effect of smoking cessation on the long-term remission in patients with Buerger's disease.

Cited by 25 publications

References 12 publications

Endarteritis Obliterans in the Pathogenesis of Buerger’s Disease From the Pathological and Immunohistochemical Points of View

Endarteritis Obliterans in the Pathogenesis of Buerger’s Disease From the Pathological and Immunohistochemical Points of View

Very distal vein bypass in patients with thromboangiitis obliterans

JCS 2017 Guideline on Management of Vasculitis Syndrome　― Digest Version ―

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The fate of ischemic limbs in patients with Buerger’s disease based on our 30-year experience: does smoking have a definitive impact on the late loss of limbs?

Abstract: This study demonstrated no significant difference in the limb salvage rate between ex-smokers and smokers. Our results do not support any advantageous effect of smoking cessation on the long-term remission in patients with Buerger's disease.

Cited by 25 publications

References 12 publications

Endarteritis Obliterans in the Pathogenesis of Buerger’s Disease From the Pathological and Immunohistochemical Points of View

Endarteritis Obliterans in the Pathogenesis of Buerger’s Disease From the Pathological and Immunohistochemical Points of View

Very distal vein bypass in patients with thromboangiitis obliterans

JCS 2017 Guideline on Management of Vasculitis Syndrome ― Digest Version ―

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Product

Resources

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JCS 2017 Guideline on Management of Vasculitis Syndrome　― Digest Version ―