ORIGINAL ARTICLES   

International Angiology 1999 March;18(1):58-64

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Factors affecting the long-term outcome of Buerger’s disease (thromboangiitis obliterans)

Shigematsu H., Shigematsu K.

From the Section of Vascular Surgery, Department of Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan

Background. Although the age at onset in ­patients with Buerger’s dis­ease is rel­a­tive­ly young, the life expec­tan­cy has been sel­dom report­ed in ­detail. The aim of this study is to study long-term ­results of Buerger’s dis­ease and fac­tors affect­ing the ultimate out­come.
Methods. From 1965 to 1980, 682 ­patients with Buerger’s dis­ease were treat­ed in our out­pa­tient depart­ment. We stud­ied their long-term stat­us, includ­ing con­com­i­tant dis­eas­es, and the dis­ease pro­gres­sion by mail.
Results. Of the 287 mail respond­ers, 266 were male and 21 were ­female, with a mean age of 60 years. One hun­dred and fifty-five of these ­patients are cur­rent­ly suf­fer­ing from clin­i­cal symp­toms. Forty-eight ­patients under­went minor ampu­ta­tion and 30 and major ampu­ta­tion. Forty-six ­patients under­went sym­pa­thec­to­my, and only 17 ­­bypass recon­struc­tion. Although there was no sig­nif­i­cant dif­fer­ence in the con­tin­u­a­tion of symp­toms ­between cur­rent smok­ers and ex-smok­ers, the ampu­ta­tion rate was high­er in cur­rent smok­ers and con­tin­u­ous smok­ing is close­ly relat­ed to both minor and major ampu­ta­tions after sym­pa­thec­to­my and to minor ampu­ta­tions after drug ther­a­py. Arteriosclerotic dis­eas­es were rec­og­nized in 57 ­patients, and gas­trod­u­od­en­al ulcer in 44. Thirty-three ­patients had died. Among 14 who died of neo­plasm, three ­ died of esoph­a­geal can­cer and lung can­cer, respec­tive­ly, which were close­ly relat­ed to smok­ing.
Conclusions. The nat­u­ral his­to­ry of the limbs in ­patients with Buerger’s dis­ease is not com­plete­ly discouraging, and in order to ­obtain a favourable out­come for ­patients with Buerger’s dis­ease we rec­om­mend com­plete smok­ing ces­sa­tion with drug-ther­a­py and sur­veil­lance for neo­plasm, espe­cial­ly of the upper gas­troin­tes­ti­nal tract and lung.