Vascular Reconstruction in Buerger's Disease: Is it Feasible?

Dilege, Şükrü; Aksoy, Murat; Kayabali, Murat; Genç, Fatih Ata; Şentürk, Mert; Baktiroğlu, Selçuk

doi:10.1007/s005950200211

Cited by 44 publications

(30 citation statements)

References 15 publications

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“…7,13 According to an international study by Cachovan et al carried out in 1986, 14 the prevalence of Buerger's disease is higher in Asia, the Middle East, and Eastern European countries than in the United States and Western Europe; however, the number of patients in Japan, Hong Kong, Turkey, Thailand, and Poland seems to be decreasing. 5,6,9,[15][16][17][18] The reason for this is unknown, but it is important to be aware of the clinical course and social consequences of this vanishing disease. 9,18 At our institution, about 17.3% of patients admitted for PAOD between 1988 and 1995 had Buerger's disease, whereas between 1996 and 2002 the percentage dropped to about 5.7%.…”

Section: Discussionmentioning

confidence: 98%

“…Conversely, in Japan there has been a significant decrease in the incidence of newly diagnosed Buerger's disease but the incidence of patients admitted for recurrence has not changed. 5,16,28 Both the occurrence and recurrence of necrotic lesions is usually arrested in patients older than 60 years. 21 The precise reason for the decreasing incidence of recurrence and prevalence in the northern part of Thailand is not known.…”

Section: Discussionmentioning

confidence: 99%

“…1 This disease was first described pathologically by von Winiwarter in 1879 2 and characterized by Leo Buerger in 1908 as a "presenile spontaneous gangrene." 3 Buerger's disease has been reported as a common vascular disease in South and Southeast Asia, the Middle East, and Eastern European countries, [4][5][6][7] but the incidence of new cases is decreasing in the United States, Europe, and Japan. 1,[5][6][7][8][9] The incidence of TAO in Thailand cannot be determined because of a lack of nationwide studies, but based on clinical experience, it is generally accepted that Thailand is one of the countries in Asia with a high incidence of this disease.…”

Section: Introductionmentioning

confidence: 99%

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Decrease in the Incidence of Buerger's Disease Recurrence in Northern Thailand

Laohapensang

Kattipattanapong

2005

Surg Today

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Decrease in the Incidence of Buerger's Disease Recurrence in Northern Thailand

Laohapensang

Kattipattanapong

2005

Surg Today

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“…n.s. Dilege (2002) 42 27 85% fd 60% (1 year)* 33% (3 years)* 92.5% (3 years) 2 Fd = femorodistal bypasses; n.s. = not stated.…”

Section: Lazarides Et Almentioning

confidence: 99%

Diagnostic Criteria and Treatment of Buerger’s Disease: A Review

Lazarides

Georgiadis

Papas

et al. 2006

The International Journal of Lower Extremity Wounds

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Buerger's disease is an inflammatory occlusive disorder affecting the small and medium-size arteries and veins of young, predominantly male, smokers. The disorder has been identified as an autoimmune response triggered when nicotine is present. Tobacco abuse is the major contributing risk factor; however, smoking seems to be a synergistic factor rather than the cause of the disease. The traditional diagnosis of Buerger's disease is based on 5 criteria (smoking history, onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, and absence of atherosclerotic risk factors other than smoking). As there is no specific diagnostic test and an absence of positive serologic markers, confident clinical diagnosis should be made only when all these 5 criteria have been fulfilled although not universally accepted. The angiographic findings in Buerger's disease ("corkscrew," "spider legs," or "tree roots") are helpful but not pathognomonic. A wide spectrum of medical or surgical therapeutic options have been proposed; however, total abstinence from tobacco use remains the only means of stopping the disease progression. The initial management of patients with Buerger's disease should be conservative. Because several arteries may be unaffected, claudicants should be encouraged to walk, whereas patients with "critical" ischemia should be admitted for bed rest in the hospital. Bypass grafting is seldom an option, as the location of the lesions distally leaves little to bypass because of lack of target vessels. A literature review revealed only a few series reporting vascular reconstruction (mainly femorodistal bypasses) in Buerger's disease. Bypass patency rates were suboptimal; however, the corresponding limb salvage rates were satisfactory. A possible explanation is that patent grafts, even over a short period of time, are sufficient to allow healing of ulcers in patients with Buerger's disease.

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“…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 contemporary series of patients with TAO treated with distal vein bypass after cessation of smoking are evaluated.…”

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confidence: 99%

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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Vascular Reconstruction in Buerger's Disease: Is it Feasible?

Cited by 44 publications

References 15 publications

Decrease in the Incidence of Buerger's Disease Recurrence in Northern Thailand

Decrease in the Incidence of Buerger's Disease Recurrence in Northern Thailand

Diagnostic Criteria and Treatment of Buerger’s Disease: A Review

Very distal vein bypass in patients with thromboangiitis obliterans

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