ORIGINAL ARTICLES   

International Angiology 2002 September;21(3):228-32

Copyright © 2003 EDIZIONI MINERVA MEDICA

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.