Download PDF
Int J Angiol 2019; 28(03): 173-181
DOI: 10.1055/s-0039-1685200
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Buerger's Disease in Endovascular Era

Baker M. Ghoneim 
1   Vascular Surgery Department, Faculty of Medicine, Cairo University, Egypt
,
Ahmed G. Karmota
1   Vascular Surgery Department, Faculty of Medicine, Cairo University, Egypt
,
Ahmed M. Abuhadema
1   Vascular Surgery Department, Faculty of Medicine, Cairo University, Egypt
,
Ahmed A. Shaker
1   Vascular Surgery Department, Faculty of Medicine, Cairo University, Egypt
,
Hany M. Abdelmawla
1   Vascular Surgery Department, Faculty of Medicine, Cairo University, Egypt
,
Mahmoud M. Nasser
1   Vascular Surgery Department, Faculty of Medicine, Cairo University, Egypt
,
Hossam Y. Elmahdy
1   Vascular Surgery Department, Faculty of Medicine, Cairo University, Egypt
,
Hesham A. Mostafa
1   Vascular Surgery Department, Faculty of Medicine, Cairo University, Egypt
,
Hussein M. Khairy
1   Vascular Surgery Department, Faculty of Medicine, Cairo University, Egypt
› Author Affiliations
Further Information

Publication History

Publication Date:
19 April 2019 (online)

    Permissions and Reprints

Abstract

This study was aimed to report data on the feasibility, safety, and effectiveness of endovascular procedures in a thromboangiitis obliterans diagnosed patients presenting with critical limb ischemia (CLI). Prospective study conducted on patients affected by Buerger's disease who presented to our center along 2 years. Clinical, radiological, and patient-based outcomes were recorded at 3, 6, and 12 months after the intervention. Total 39 patients were included in the study. Fifteen (38.5%) patients underwent percutaneous transluminal angioplasty, another 15 patients (38.5%) underwent follow-up on medical treatment, there are four other patients (10.3%) underwent surgical bypass, and five (12.8%) patients underwent lumbar sympathectomy. The 12 months' outcome showed 66.7% technical success in endovascular group with 46.7% patency rate (p-value = 0.06), 86.7% limb salvage rate (LSR; p-value < 0.04), and 66.7% clinical improvement (p-value = 0.005). The endovascular management of Buerger's disease is feasible, save, and effective with high rate of LSR and clinical improvement.

Keywords

angioplasty - arteritis - Buerger's disease - catheter-directed - thrombolysis - critical limb ischemia - endovascular procedure - nicotine
 

  • References

  • 1 Arkkila PE. Thromboangiitis obliterans (Buerger's disease). Orphanet J Rare Dis 2006; 1 (01) 14
    CrossrefPubMedGoogle Scholar
  • 2 Hooten WM, Bruns HK, Hays JT. Inpatient treatment of severe nicotine dependence in a patient with thromboangiitis obliterans (Buerger's disease). Mayo Clin Proc 1998; 73 (06) 529-532
    CrossrefPubMedGoogle Scholar
  • 3 Graziani L, Piaggesi A. Indications and clinical outcomes for below knee endovascular therapy: review article. Catheter Cardiovasc Interv 2010; 75 (03) 433-443
    PubMedGoogle Scholar
  • 4 Graziani L, Morelli L, Parini F. , et al. Clinical outcome after extended endovascular recanalization in Buerger's disease in 20 consecutive cases. Ann Vasc Surg 2012; 26 (03) 387-395
    CrossrefPubMedGoogle Scholar
  • 5 Shionoya S. Diagnostic criteria of Buerger's disease. Int J Cardiol 1988; 66 (Suppl. 01) S243-S5
    PubMedGoogle Scholar
  • 6 McCaffery M, Beeby A. , et al. Pain: Clinical Manual for Nursing Practice. St Louis, MO: Mosby; 1989
    Google Scholar
  • 7 Fazeli B, Dadgar Moghadam M, Niroumand S. How to treat a patient with thromboangiitis obliterans: a systematic review. Ann Vasc Surg 2018; 49: 219-228
    CrossrefPubMedGoogle Scholar
  • 8 Kobayashi M, Sugimoto M, Komori K. Endarteritis obliterans in the pathogenesis of Buerger's disease from the pathological and immunohistochemical points of view. Circulation 2014; 78 (12) 2819-2826
    PubMedGoogle Scholar
  • 9 De Caridi G, Bitto A, Massara M. , et al. Increased Serum HMGB-1, ICAM-1 and Metalloproteinase-9 Levels in Buerger's Patients. Curr Vasc Pharmacol 2016; 14 (04) 382-387
    CrossrefPubMedGoogle Scholar
  • 10 Fazeli B, Ravari H. Mechanisms of thrombosis, available treatments and management challenges presented by thromboangiitis obliterans. Curr Med Chem 2015; 22 (16) 1992-2001
    CrossrefPubMedGoogle Scholar
  • 11 Klein-Weigel P, Volz TS, Zange L, Richter J. Buerger's disease: providing integrated care. J Multidiscip Healthc 2016; 9: 511-518
    CrossrefPubMedGoogle Scholar
  • 12 Dae-Hoon K, Ko Y-G, Ahn C-M. , et al. Immediate and late outcomes of endovascular therapy for lower extremity arteries in Buerger disease. J Vasc Surg 2018; 67 (06) 1769-1777
    CrossrefPubMedGoogle Scholar
  • 13 Mills JL, Taylor Jr. LM, Porter JM. Buerger's disease in the modern era. Am J Surg 1987; 154 (01) 123-129
    CrossrefPubMedGoogle Scholar
  • 14 Ates A, Yekeler I, Ceviz M. , et al. One of the most frequent vascular diseases in northeastern of Turkey: Thromboangiitis obliterans or Buerger's disease (experience with 344 cases). Int J Cardiol 2006; 111 (01) 147-153
    CrossrefPubMedGoogle Scholar
  • 15 Lee JH, Ko YG, Choi D. Endovascular Treatment of Multilevel Chronic Total Occlusion Using a Stent Puncture Technique in Buerger's Disease. Korean Circ J 2016; 46 (03) 417-420
    CrossrefPubMedGoogle Scholar
  • 16 Aragón-Sánchez J, Rabellino M, Pulido-Duque J, Zander T, González G, Maynar M. Endovascular treatment is a hope for patient with Buerger's disease and foot ulcer: case report. Int J Low Extrem Wounds 2012; 11 (03) 165-168
    CrossrefPubMedGoogle Scholar
  • 17 Mustapha JA, Finton SM, Diaz-Sandoval LJ, Saab FA, Miller LE. Percutaneous transluminal angioplasty in patients with infrapopliteal arterial disease: systematic review and meta-analysis. Circ Cardiovasc Interv 2016; 9 (05) e003468
    PubMedGoogle Scholar
  • 18 Choi CY, Park SH, Choi HY. Successful complex endovascular intervention for a patient with typical buerger's disease. Soonchunhyang Med Sci 2016; 22 (01) 54-58
    CrossrefPubMedGoogle Scholar
  • 19 Ryu HM, Kim JS, Ko YG, Hong MK, Jang Y, Choi D. Clinical outcomes of infrapopliteal angioplasty in patients with critical limb ischemia. Korean Circ J 2012; 42 (04) 259-265
    CrossrefPubMedGoogle Scholar
  • 20 Schamp KB, Meerwaldt R, Reijnen MM, Geelkerken RH, Zeebregts CJ. The ongoing battle between infrapopliteal angioplasty and bypass surgery for critical limb ischemia. Ann Vasc Surg 2012; 26 (08) 1145-1153
    CrossrefPubMedGoogle Scholar
  • 21 Lo RC, Darling J, Bensley RP. , et al. Outcomes following infrapopliteal angioplasty for critical limb ischemia. J Vasc Surg 2013; 57 (06) 1455-1463 , discussion 1463–1464
    CrossrefPubMedGoogle Scholar
  • 22 Mills Sr JL. Infrainguinal disease: surgical treatment. In: Cronenwett JL, Johnston KE. , eds. Rutherford's Vascular Surgery. 8th ed. Philadelphia, PA: Elsevier-Saunders; 2010: 1758-1781
    Google Scholar