Immediate and late outcomes of endovascular therapy for lower extremity arteries in Buerger disease.

Abstract

OBJECTIVE:

Buerger disease is a rare inflammatory vasculopathy presenting with severe claudication or critical limb ischemia. In this study, we sought to evaluate the feasibility and clinical outcomes of endovascular therapy for Buerger disease involving arteries in the lower extremities.

METHODS:

Between January 2006 and May 2016, there were 44 Buerger disease patients (43 men; mean age, 40.4 ± 9.6 years) with 50 target limbs treated by endovascular therapy at the Severance Cardiovascular Hospital. Baseline characteristics as well as both immediate and late clinical outcomes were retrospectively analyzed.

RESULTS:

The majority (86.4%) of patients presented with critical limb ischemia. A total of 88 target lesions in 50 limbs were treated with endovascular procedures. All limbs showed infrapopliteal artery occlusions, and multilevel diseases involving the iliac or femoropopliteal artery were found in 31 patients (62%). Technical success was achieved in 80% of subjects. We found that a lower serum level of C-reactive protein, specifically the log C-reactive protein value (odds ratio, 0.03; 95% confidence interval [CI], 0.00-0.71; P = .030), was an independent predictor of technical failure. The median follow-up duration was 29 months. Major adverse limb event-free survival and reintervention- and amputation-free survival were 83.3% and 67.9% at 3 years, respectively. In a multivariate Cox proportional hazards analysis, previous endovascular treatment (hazard ratio, 3.70; 95% CI, 1.20-11.31; P = .022) and previous amputation (hazard ratio, 4.68; 95% CI, 1.37-15.96; P = .014) were identified as independent risk factors for reintervention- and amputation-free survival.

CONCLUSIONS:

In patients with Buerger disease, endovascular treatment achieved technical success in the majority of the cases and was associated with favorable immediate and late clinical outcomes. These findings indicate that endovascular therapy may be considered a first-line treatment option for severe symptomatic patients with Buerger disease.

• Authors: Dae-Hoon Kim, Young-Guk Ko, Chul-Min Ahn, Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 67 Issue 6 Pg. 1769-1777 (06 2018) ISSN: 1097-6809 [Electronic] United States
• PMID: 29157680 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Disease-Free Survival
• Endovascular Procedures (methods)
• Female
• Femoral Artery (diagnostic imaging, surgery)
• Follow-Up Studies
• Humans
• Iliac Artery (diagnostic imaging, surgery)
• Incidence
• Intermittent Claudication (diagnosis, surgery)
• Lower Extremity (blood supply)
• Male
• Odds Ratio
• Postoperative Complications (epidemiology)
• Republic of Korea (epidemiology)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Survival Rate (trends)
• Thromboangiitis Obliterans (complications, diagnosis, surgery)
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• Ultrasonography, Doppler, Duplex