Clinical outcomes of extended endovascular recanalization of 16 consecutive Buerger’s disease patients

Abstract

Objective

Buerger’s disease is one of the worst diseases causing peripheral artery occlusions (especially lower extremity) with increased morbidity and mortality. Endovascular treatment of the diseased arteries gains preference over bypass surgery nowadays. Here, we aimed to present the clinical outcomes of 16 consecutive Buerger’s disease patients underwent extended endovascular recanalization which is a new technique to restore direct blood flow to at least one foot artery, with the performance of angioplasty for each tibial and foot artery obstructions.

Methods

A total of 16 consecutive patients with confirmed diagnosis of Buerger’s disease that percutaneously treated in our center between February 2014 and March 2018 were included in the study. The mean age of the patients was 44.25 ± 4.28 ranging from 36 to 50 years. After physical examination and complementary diagnostic tests, performance of extended angioplasty for occluded arteries was intended to restore direct blood flow to at least one of the blow-the-knee arteries.

Results

A successful extended endovascular treatment was performed in 20 of 22 limbs, achieving a technical success of 91%. All patients were successfully discharged without any complication. Mean follow-up duration was 21.43 ± 7.08 months. Reintervention was performed in one patient and minor amputation was needed in one of the failed limbs. Limb salvage rate was 100%. A significant difference was observed based on Rutherford classification, ankle brachial index, direct blood flow to foot, presence of ulcer and rest pain when compared before and after the intervention.

Conclusion

We showed successful extended endovascular recanalization of Buerger’s disease patients with a high technical success rate and sustained clinical improvement. Extended endovascular recanalization could be a therapeutic option in Buerger’s disease patients, since they are not good candidates for surgery.

Keywords

TAO Beurger’s disease extended endovascular treatment percutaneous transuminal angioplasty PTA

Get full access to this article

View all access options for this article.

References

Fazeli

Rezaee

SA.

A review on thromboangiitisobliterans pathophysiology: thrombosis and angiitis, which is to blame?

Vascular 2011; 19: 141–153.

Puechal

Fiessinger

JN.

Thromboangiitisobliterans or Buerger’s disease: challenge for the rheumatologist. Rheumatology 2007; 46: 192–199.

Fujii

Soga

Nakamura

et al . Classification of corkscrew collaterals in thromboangiitisobliterans (Buerger’s disease): relationship between corkscrew type and prevalence of ischemic ulcers. Circ J 2010; 74: 1684–1688.

Fiessinger

Schäfer

Trial of iloprost versus aspirin treatment for critical limb ischaemia of thromboangiitisobliterans. The TAO Study. Lancet 1990; 335: 555.

Olin

JW.

Thromboangiitisobliterans (Buerger’s disease). N Engl J Med 2000; 343: 864–868.

Labropoulos

Watson

Mansour

et al . Acute effects of intermittent pneumatic compression on popliteal artery blood flow. Arch Surg 1998; 133: 1072.

Isner

Baumgartner

Rauh

et al . Treatment of thromboangiitisobliterans (Buerger's disease) by intramuscular gene transfer of vascular endothelial growth factor: preliminary clinical results. J Vasc Surg 1998; 28: 964.

Idei

Soga

Hata

et al . Autologous bone-marrow mononuclear cell implantation reduces long-term major amputation risk in patients with critical limb ischemia: a comparison of atherosclerotic peripheral arterial disease and Buerger disease. Circ Cardiovasc Interv 2011; 4: 15.

Baumann

Stangl

Klein-Weigel

et al . Successful treatment of thromboangiitisobliterans (Buerger's disease) with immunoadsorption: results of a pilot study. Clin Res Cardiol 2011; 100: 683.

10.

Inan

Alat

Kutlu

et al . Successful treatment of Buerger's disease with intramedullary K-wire: the results of the first 11 extremities. Eur J Vasc Endovasc Surg 2005; 29: 277.

11.

De Haro

Acin

Bleda

et al . Treatment of thromboangiitisobliterans (Buerger's disease) with bosentan. BMC Cardiovasc Disord 2012; 12: 5.

12.

Reilly

Mohler

3rd.

Cilostazol: treatment of intermittent claudication. Ann Pharmacother 2001; 35: 48.

13.

Dilege

Aksoy

Kayabali

et al . Vascular reconstruction in Buerger’s disease: is it feasible? Surg Today 2002; 32: 1042–104700.

14.

Shindo

Matsumoto

Arterial reconstruction in Buerger’s disease: by-pass to disease-free collaterals. Int Angiol 2002; 21: 228–232.

15.

Shionoya

Diagnostic criteria of Buerger’s disease. Int J Cardiol 1998; 66: S243–S245.

16.

Adam

Bradbury

AW.

Tasc II document on the management of peripheral arterial disease. Eur J Vasc Endovasc Surg 2007; 33: 1–2.

17.

Zwiebel

Pellerito

JS.

Basic concepts of Doppler frequency spectrum analysis and ultrasound blood flow imaging. In: Zwiebel

Pellerito

(eds) Introduction to vascular ultrasonography. 5th ed. Philadelphia: Elsevier Saunders, 2004, pp. 61–89.

18.

Kotval

PS.

Doppler waveform parvus and tardus: a sign of proximal flow obstruction. J Ultrasound Med 1989; 8: 435–440.

19.

Faglia

Mantero

Caminiti

et al . Extensive use of peripheral angioplasty, particularly infrapopliteal, in the treatment of ischaemic diabetic foot ulcers: clinical results of a multicentric study of 221 consecutive diabetic subjects. J Intern Med 2002; 252: 225–232.

20.

Faglia

Dalla Paola

Clerici

et al . Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur J Vasc Endovasc Surg 2005; 29: 620–627.

21.

Kaçmaz

Kaya

Yazıcı

Successful sequential drug eluting balloon angioplasty to chronic total occluded popliteal artery in a patient with thromboangiitis obliterans by PCR. Anatol J Cardiol 2016; 16: 450.

22.

Kudo

Chandra

Ahn

SS.

The effectiveness of percutaneous transluminal angioplasty for the treatment of critical limb ischemia: a 10-year experience. J Vasc Surg 2005; 41: 423–435; discussion 435.

23.

Ahn

Rutherford

Becker

et al . Reporting standards for lower extremity arterial endovascular procedures. J Vasc Surg 1993; 17: 1103–1107.

24.

Rutherford

Baker

Ernst

et al . Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997; 26: 517–538.

25.

Hooten

Bruns

Hays

JT.

Inpatient treatment of severe nicotine dependence in a patient with thromboangiitisobliterans (Buerger’s disease). Mayo Clin Proc 1998; 73: 529–532.

26.

Joyce

JW.

Buerger’s disease (thromboangiitisobliterans). Rheum Dis Clin North Am 1990; 16: 463–470.

27.

Puéchal

Fiessinger

JN.

Thromboangiitisobliterans or Buerger’s disease: challenge for the rheumatologist. Rheumatology (Oxford) 2007; 46: 192–199.

28.

Lau

Cheng

SW.

Buerger’s disease in Hong Kong: a review of 89 cases. Aust N Z J Surg 1997; 67: 264–269.

29.

Talwar

Choudhary

SK.

Omentopexy for limb salvage in Buerger’s disease: indications, technique and results. J Postgrad Med 2001; 47: 137–142.

30.

Kim

Han

Chae

et al . Successful stem cell therapy using umbilical cord blood-derived multipotent stem cells for Buerger’s disease and ischemic limb disease animal models. Stem Cells 2006; 24: 1620–1626.

31.

Donas

Schulte

Ktenidis

et al . The role of epidural spinal cord stimulation in the treatment of Buerger’s disease. J Vasc Surg 2005; 41: 830–836.

32.

Modaghegh

Kazemzadeh

Ravari

et al . Buerger’s disease in the northeast of Iran: epidemiology and clinical features. Vascular 2015; 23: 519–524.

33.

Bozkurt

Be şi rli

et al . Surgical treatment of Buerger’s disease. Vascular 2004; 12: 192–197.

34.

Sayin

Bozkurt

Tüzün

et al . Surgical treatment of Buerger’s disease: experience with 216 patients. Cardiovasc Surg 1993; 1: 377–380.

35.

Dilege

Aksoy

Kayabali

et al . Vascular reconstruction in Buerger’s disease: is it feasible? Surg Today 2002; 32: 1042–1047.

36.

Graziani

Morelli

Parini

et al . Clinical outcome after extended endovascular recanalization in Buerger’s disease in 20 consecutive cases. Ann Vasc Surg 2012; 26: 387–395.

37.

Yuan

Bao

Zhao

et al . Clinical results of percutaneous transluminal angioplasty for thromboangiitisobliterans in arteries above the knee. Atherosclerosis 2014; 235: 110–115.

38.

Kawarada

Kume

Ayabe

et al . Endovascular therapy outcomes and intravascular ultrasound findings in thromboangiitisobliterans (Buerger’s disease). J Endovasc Ther 2017; 24: 504–515.