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?
OBJECTIVE
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.
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.
Masayuki
M
Sugimoto
Hiroki
H
Miyachi
Hirofumi
H
Morimae
Akio
A
Kodama
Hiroshi
H
Narita
Hiroshi
H
Banno
Kiyohito
K
Yamamoto
Kimihiro
K
Komori
D000328:Adult; D017668:Age of Onset; D001158:Arteries / Q000601:surgery; D005121:Extremities / Q000098:blood supply*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia; D023821:Limb Salvage / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods*; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016540:Smoking Cessation; D013562:Sympathectomy; D013919:Thromboangiitis Obliterans / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods