Fate of ischemic limbs in patients with Buerger's disease based on our 30-year experience: does smoking have a definitive impact on the late loss of limbs?

Autor: Sugimoto M; Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan, msugi@med.nagoya-u.ac.jp., Miyachi H, Morimae H, Kodama A, Narita H, Banno H, Yamamoto K, Komori K
Jazyk: angličtina
Zdroj: Surgery today [Surg Today] 2015 Apr; Vol. 45 (4), pp. 466-70. Date of Electronic Publication: 2014 Apr 26.
DOI: 10.1007/s00595-014-0904-6
Abstrakt: Purpose: We herein review the long-term results of our series of critical ischemic limbs caused by Buerger's disease.
Methods: A retrospective review of 103 patients with critical limb ischemia who were diagnosed with Buerger's disease by Shionoya's criteria between 1980 and 2010.
Results: The age of onset was 38.0 ± 9.7 years (mean ± SD). The median follow-up was 97 months. Thirty-three patients had pain at rest, and 65 patients presented with ischemic ulcers in their toes and/or fingers. Gangrene was present in five patients. Sixteen patients achieved remission with medical therapy and smoking cessation. Sixty-six patients underwent sympathectomy. Bypass to the crural arteries was performed in 23 limbs, with assisted primary patency rates of 67.0 and 45.6 % at five and 10 years. Graft failure caused major amputation in two out of 10 smokers, but no limbs were lost among the 12 ex-smokers. Therapeutic angiogenesis using cell transplantation led to improvement in three ex-smokers; however, amputation was unavoidable in the one smoker who was treated. The limb salvage rate at 20 years was 90 % in ex-smokers and 69 % in smokers, which was not significantly different.
Conclusions: This study demonstrated no significant difference in the limb salvage rate between ex-smokers and smokers. Our results do not support any advantageous effect of smoking cessation on the long-term remission in patients with Buerger's disease.
Databáze: MEDLINE
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