The role of polytetrafluoroethylene graft material in Buerger's disease (original) (raw)
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Management of Buerger's Disease in Endovascular Era
International Journal of Angiology, 2019
This study was aimed to report data on the feasibility, safety, and effectiveness of endovascular procedures in a thromboangiitis obliterans diagnosed patients presenting with critical limb ischemia (CLI). Prospective study conducted on patients affected by Buerger's disease who presented to our center along 2 years. Clinical, radiological, and patient-based outcomes were recorded at 3, 6, and 12 months after the intervention. Total 39 patients were included in the study. Fifteen (38.5%) patients underwent percutaneous transluminal angioplasty, another 15 patients (38.5%) underwent follow-up on medical treatment, there are four other patients (10.3%) underwent surgical bypass, and five (12.8%) patients underwent lumbar sympathectomy. The 12 months' outcome showed 66.7% technical success in endovascular group with 46.7% patency rate (p-value = 0.06), 86.7% limb salvage rate (LSR; p-value
Journal of Vascular Surgery, 2008
Background: Peripheral arterial disease is a significant problem worldwide. In developing countries such as India, the increased incidence of smoking and other forms of nicotine intake has resulted in a large proportion of young individuals with Buerger's disease. The results of surgical and endovascular treatment for this condition have not been very rewarding. Hence, we focused on providing alternative therapies. Neovascularization by autologous bone marrow mononuclear cell transplantation is being tried as an alternative therapeutic option. We have reviewed our series of patients who underwent autologous bone marrow mononuclear cell transplantation during the last 2 years. Methods: We enrolled 38 patients who were chosen to undergo autologous bone marrow mononuclear cell transplantation for nonreconstructible Buerger's disease. We injected the bone marrow mononuclear cells into the calf muscles of the affected limbs in 36 patients. We monitored ulcer healing, ankle-brachial index (ABI), and transcutaneous oximetry (TcPO 2) level. Results: No procedurally related complications occurred, although one injected sample of bone marrow aspirate later revealed infestation with Strongyloides stercoralis. Two patients were seropositive on the Venereal Disease Research Laboratory test and were not injected with the bone marrow mononuclear cells. Three patients (12%) underwent major amputations <6 months. The others had improvements in their ulcer healing, an increase in the mean ABI of 0.14 (range, 0.1-0.19; P < .01), and improvement in the mean TcPO 2 of 52 mm Hg (range, 40-68 mm Hg, P < .01), with resultant limb salvage in all at 6 months. All patients discontinued smoking during the study period. Conclusions: Use of bone marrow-derived progenitor cell transplantation into ischemic limbs is a relatively safe procedure with no demonstrable side effects at 6 months. These study data support conducting controlled and multicenter trials to evaluate the efficacy of this therapy in preventing amputation in selected patients with Buerger's disease who have critical limb ischemia.
Journal of the American Heart Association, 2018
Background Data regarding long‐term outcome of patients with thromboangiitis obliterans are lacking and most series come from India and Japan. In this study, we assess long‐term outcome and prognostic factors in a large cohort of thromboangiitis obliterans. Methods and Results Retrospective multicenter study of characteristics and outcomes of 224 thromboangiitis obliterans patients fulfilling Papa's criteria were analyzed. Factors associated with vascular events and amputations were identified. The median age at diagnosis was 38.5 (32–46) years, 51 (23.8%) patients were female, and 81.7% were whites. After a mean follow‐up of 5.7 years, vascular events were observed in 58.9%, amputations in 21.4%, and death in 1.4%. The 5‐, 10‐, and 15‐year vascular event‐free survival and amputation‐free survival were 41% and 85%, 23% and 74%, and 19% and 66%, respectively. Ethnic group (nonwhite) (hazard ratio 2.35 [1.30–4.27] P =0.005) and limb infection at diagnosis (hazard ratio 3.29 [1.02–...
Vascular, 2018
ObjectiveBuerger’s disease is one of the worst diseases causing peripheral artery occlusions (especially lower extremity) with increased morbidity and mortality. Endovascular treatment of the diseased arteries gains preference over bypass surgery nowadays. Here, we aimed to present the clinical outcomes of 16 consecutive Buerger’s disease patients underwent extended endovascular recanalization which is a new technique to restore direct blood flow to at least one foot artery, with the performance of angioplasty for each tibial and foot artery obstructions.MethodsA total of 16 consecutive patients with confirmed diagnosis of Buerger’s disease that percutaneously treated in our center between February 2014 and March 2018 were included in the study. The mean age of the patients was 44.25 ± 4.28 ranging from 36 to 50 years. After physical examination and complementary diagnostic tests, performance of extended angioplasty for occluded arteries was intended to restore direct blood flow to ...
Indian Journal of Surgery, 2011
In Buerger’s disease conservative treatment is questionable. Arterial reconstructive surgery is not feasible and sympathectomy has limited role. Progression of the disease invariably leads to amputation. Ilizarov’s method increases the vascularity of the ischaemic limb. Retrospective analysis of Ilizarov’s technique in 60 patients was done. Immediate results took into account rest pain, colour of skin, venous return, temperature, pulse oxymeter measured oxygen saturation and ulcer/amputation stump wound healing. Early and late results took into account rest pain, healing of ulcers/amputation stump with or without plastic coverage, claudication distance, resumption of previous occupation and domestic ambulation. The mean follow up of patients was 63 months. Immediate results were promising except two amputations. Early result were excellent to good in 56 and late results were excellent to good in 48 patients. Deterioration had significant correlation with smoking. Ilizarov’s method is an excellent and cheap procedure in treatment of Buerger’s disease.
Annals of Vascular Surgery, 2013
Background: Prosthetic grafts for lower-extremity bypass have limited patency compared with autologous vein grafts. Precuffed expanded polytetrafluoroethylene (ePTFE) grafts alter the geometry of the distal hood to improve patency. This study reports the authors' long-term results on the use of precuffed ePTFE grafts for infrainguinal bypasses in patients with arterial occlusive disease and compares these with results of reversed great saphenous vein grafts (rSVG). Methods: A retrospective review of billing codes identified 101 polytetrafluoroethylene (PTFE) and 47 rSVG bypasses performed over a 6-year period. Femoral to below-knee popliteal and femoral to tibial bypasses were analyzed. Data collected consisted of risk factors, Rutherford classification, bypass inflow and outflow, runoff vessels, patency, amputation, and death. Primary end points consisted of primary, assisted-primary, and secondary patency along with limb salvage. Results: Mean age of the patients was 76 years in the PTFE group and 69.8 years in the rSVG group. For femoral to below-knee popliteal bypasses, primary patency at 1, 3, and 5 years in the PTFE group was 76.9%, 48.7%, and 43.3%, respectively, compared with 77.1%, 77.1%, and 77.1%, respectively, in the rSVG group (P ¼ 0.225). Secondary patency was 89.2%, 70.9%, and 50.6% in the PTFE group compared with 84.4%, 84.4%, and 84.4% in the rSVG group (P ¼ 0.269). Limb salvage was similar in the PTFE compared with the rSVG group (97.7%, 90.5%, and 79.4% vs. 83.3%, 83.3%, and 83.3%; P ¼ 0.653). For femoral to tibial bypasses, primary patency in the PTFE group at 1, 3, and 5 years was 57.1%, 40.4%, and 22.1%, respectively, compared with 67.4%, 67.4%, and 50.6%, respectively, for the rSVG group (P ¼ 0.246). Secondary patency was 75.5%, 44.9%, and 22.7% in the PTFE group compared with 91.8%, 91.8%, and 52.5% in the rSVG group (P ¼ 0.022). Limb salvage at 1, 3, and 5 years was 79.2%, 55.7%, and 55.7%, respectively, in the PTFE group compared with 96.4%, 96.4%, and 64.3%, respectively, in the rSVG group (P ¼ 0.046). Conclusions: Precuffed ePTFE grafts demonstrate similar 1-year patency to that of rSVG. However, mid-and long-term patency is reduced compared with saphenous vein grafts (SVG), especially to tibial targets. PTFE grafts to the popliteal demonstrate limb salvage rates similar to those of SVG. In the tibial vessels, limb salvage rates for PTFE grafts are significantly worse compared with SVG.
Thromboangiitis Obliterans (Buerger's Disease): Searching for a Therapeutic Strategy
Angiology, 2007
Thromboangiitis obliterans (TAO) is a nonatherosclerotic, segmental inflammatory disease that most commonly affects the small and medium-sized arteries and veins in the upper and lower extremities. Cigarette smoking has been implicated as the main etiology of the disease. In eastern parts of the world TAO forms 40-60% of peripheral vascular diseases. Clinical features and angiographic finding are the basis of early diagnosis of TAO. Abstinence from smoking is the only definitive treatment to prevent disease progression. Medical management in form of aspirin, pentoxyfylline, cilostazol, and verapamil increase pain-free walking distance in intermittent claudication, but long term usage fails to prevent disease progression in patients who continue to smoke. Surgical treatment in form of revascularization, lumbar sympathectomy, omentopexy, and Ilizarov techniques help reduce pain and promote healing of trophic changes. Newer treatment modalities like spinal cord stimulation, prostacyclin, bosentan, VEGF, and stem cell therapy have shown promising results. Latest treatment options include peripheral mononuclear stem cell, and adipose tissue derived mononuclear stem cells have been shown to be effective in preventing disease progression, decrease major amputation rates, and improving quality of life.
Journal of Vascular Surgery, 1988
Secondary vascular procedures m below-knee vessels for lower extremity ischemia present a challenge to the vascular surgeon. Autogenous vein is often unavailable and failure of the previous bypass often limits the choice of distal vessels suitable for revascularization. This dilemma raises the question of amputation vs secondary vascular surgery. To address this question we reviewed the results of our previous aggressive approach to revascularization in a select group of 25 patients (26 limbs) who had secondary procedures with polytetrafluoroethylene grafts to tibial vessels or the infragenicular popliteal artery with singlewessel runoff. Nine of these 26 bypasses (35%) have remained patent for a mean of 17.2 months and no amputations have been done in this group. The other 17 bypasses (65%) have occluded from I day to 36 months postoperatively (mean 4.3 months); 15 of these limbs have required major amputation (58%). Ten were performed within the first 3 months postoperatively. Thirteen of the 25 patients died in the follow-up period (mean 27.5 months); five of these patients had viable limbs. Of 12 surviving patients (mean follow-up 19.9 months), six had viable limbs and six have required amputation. These results indicate that patients having secondary vascular surgical procedures with polytetrafluoroethylene grafts to tibial vessels have a high amputation rate and poor overall survival. Within this select group Of patients, those who could walk with the aid of a prosthesis should be considered as candidates for primary amputation. This would facilitate rehabilitation and avoid the anguish of recurrent graft failure and multiple procedures. (J VAsc SURG 1988;8:137-42.) Failure of a previously constructed femoropopliteal or femorotibial bypass constitutes a problem frequently seen in vascular surgery. 1-3 With failure of the primary grafting procedure most patients return to their preoperative status or deteriorate, thereby facing limb loss. These patients will require a secondary procedure, either thrombectomy, revascularization, or amputation. Secondary bypasses are nearly always below the knee, often have limited singlevessel rtmoff, and usually require the use of prosthetic material. The initial failure suggests these patients have inherent factors working to limit the success From the