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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2002 September;21(3):228-32

lingua: Inglese

Arterial reconstruction in Buerger’s disease: by-pass to disease-free collaterals

Shindo S., Matsumoto H., Ogata K., Kubota K., Kojima A., Ishimoto T., Iyori K., Kobayashi M., Tada Y.

From ­the Second Department of Surgery, Yamanashi Medical University, Yamanashi, Japan


Background. Arterial recon­struc­tions ­for ische­mia in ­patients ­with Buerger’s dis­ease ­are tech­ni­cal­ly chal­leng­ing. This ret­ro­spec­tive ­review ­was con­duct­ed to iden­ti­fy ­the crit­i­cal fac­tor ­for a suc­cess­ful out­come in ­bypass sur­gery ­for Buerger’s dis­ease.
Methods. Design of ­study: ret­ro­spec­tive ­review. Setting: University hos­pi­tal, hos­pi­tal­ized ­patients. Patients: ­since 1993, we per­formed 10 arte­ri­al recon­struc­tions in 8 ­patients ­with Buerger’s dis­ease. There ­were 8 tibi­al ­artery bypass­es ­and 2 col­lat­er­al ­artery bypass­es. One ­bypass ­was per­formed in ­the ­upper extrem­ity. Interventions: bypass sur­gery ­with autog­e­nous ­vein ­graft. Main out­come meas­ure­ments: graft paten­cy.
Results. Over a ­mean fol­low-up peri­od of 41.8 ­months, ­there ­were 3 ­graft occlu­sions. Of ­these, 2 ­were of bypass­es to a pat­ent ­but dis­eased tibi­al ­artery. One ­graft ­was occlud­ed ­due to a ­toe sten­o­sis ­which ­had ­been pre­vi­ous­ly detect­ed. The 2 col­lat­er­al ­artery bypass­es ­were pat­ent at ­the ­last fol­low-up.
Conclusions. In Buerger’s dis­ease, dis­tal arte­ri­al recon­struc­tion is fre­quent­ly nec­es­sary to pre­vent ischem­ic ­limb ­loss. Collateral ­artery ­bypass is an ­option ­when ­the ­main arter­ies ­are affect­ed by ­the dis­ease. A pat­ent ­but dis­eased ­artery ­should be avoid­ed as a tar­get ­for recon­struc­tion.

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