[Surgical aspects of Buerger's disease].
BACKGROUND
The Buerger's disease (BD) is known for more than 100 years. It inflicts especially young men, smokers, at the age of about 40 and manifests itself by ischemia in the periphery of limbs which cannot be explained by precedent injury, embolism, diabetes or hyperlipemia. The disease inflicts the medium or small peripheral arteries of extremities. The occurrence of BD is most frequent in the Mediterranean and East-Asian countries. The therapy is so far symptomatic and is unsuccessful in cases when the patient is reluctant to cease smoking.


OBJECTIVE
The study is aimed at ascertainment of the results of surgical therapy in 14 patients with BD hospitalized in the Surgical Clinic FN in Plzen during the period from 1986 to 1995.


METHODS
The average age of patients was 39.6 +/- 1.2 y. The ratio males/females was 13:1. All patients were smokers. 4 patients had a trophic defect in the periphery of the upper and 11 of the lower limbs. 9 (64.3%) patients displayed the Raynod's phenomenon and seven (50%) had thrombophlebitis. All patients were treated conservatively (vasodilators, anticoagulants, antiaggregants, corticoids, prostacyclins, nifedipine). Sympatectomy (lumbal, upper thorax) was performed in 10 (71.4%), and profundoplasty in 2 patients (14.3%).


RESULTS
Conservative therapy, sympatectomy and revascularization methods failed to have a long-term effect. Repeated hospitalization of the patients was necessary, namely 7 times in average, and limbs were amputated in high percentage of patients (50%). However in cases when patients ceased smoking, the disease withdrew or became stabilized.


CONCLUSIONS
Despite the fact that BD has become less frequent in our population, it still disables young groups of patients. The therapy is so far symptomatic and the successfulness of therapy strongly depends on the patient's willingness to cooperate (cessation of smoking) and as such it is often unsuccessful. The surgical therapy, so far, fails to have a long-term effect and high percentage of limb amputation is necessary. (Ref. 11.).
Treska
V
V
Chirurgická klinika FN v Plzni.
Cechura
M
M
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D013919:Thromboangiitis Obliterans / Q000601:surgery*