Arterial Bypasses for Patients with Buerger's Disease

Kim, Gyun Ji; Park, Ui Jun; Yun, Woo Sung; Mun, Goo Hyun; Kim, Dong Ik; Kim, Young Wook

Abstract

PURPOSE
Buerger's disease (thromboangiitis obliterans) is a non-atherosclerotic inflammatory vasoocclusive disease that affects the small- and medium-sized vessels of the extremities, and especially in young smokers. It is known that abstinence of smoking is the most effective treatment for Buerger's disease and surgical treatment is not frequently done because its result is not as good as that for atherosclerosis. We performed this study to determine the clinical implications and the effectiveness of arterial bypass surgery for limb salvage in patients with Buerger's disease.
METHODS
We retrospectively reviewed the patients with Buerger's disease and who underwent arterial bypass surgery between September 2003 and August 2008. We followed the criteria of Shionoya that was reported in 1998 to diagnose Buerger's disease. The indications of surgery were patients with disabling claudication, severe resting pain, non-healing ulcer or gangrene, and non-diseased proximal and distal arteries were available for anastomosis. We evaluated the patency of the grafts with duplex ultrasonography or CT angiography after surgery.
RESULTS
Arterial bypass surgery was performed in 16 lower extremities of 14 patients. An autologous venous graft was used in 12 limbs and a polytetrafluoroethylene graft was used in 4 limbs. Major amputation was performed in 2 limbs and reconstruction with a myocutaneous free flap after minor amputation was performed in 2 limbs. The patency rates of the arterial bypasses were 66.1%, 66.1% and 66.1% at 1, 3 and 5 years, respectively, and the limb salvage rates were 92.9%, 84.4% and 84.4% at 1, 3 and 5 years, respectively.
CONCLUSION
Arterial bypass surgery could be considered as a favorable limb salvage treatment for the Buerger's disease patients with limited indications.