Long‐Term Outcome and Prognostic Factors of Complications in Thromboangiitis Obliterans (Buerger's Disease): A Multicenter Study of 224 Patients

Abstract

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 [1.02–10.6] P =0.045) were independent factors of vascular event‐free survival. Factor associated with amputation was limb infection (hazard ratio 12.1 [3.5–42.1], P <0.001). Patients who stopped their tobacco consumption had lower risk of amputation ( P =0.001) than those who continued. Conclusions This nationwide study shows that 34% of thromboangiitis obliterans patients will experience an amputation within 15 years from diagnosis. We identified high‐risk patients for vascular complications and amputations.

Long-Term Clinical Outcomes of Autologous Bone Marrow Mononuclear Cell Implantation in Patients With Severe Thromboangiitis Obliterans

“…Despite the rarity of TAO diagnoses in women, the proportion of women diagnosed with TAO has been reported to range between 10% and 23%. 1,[18][19][20][21][22] In the present study, there was difference in the proportion of males and females in the BM-MNC implantation and historical control groups. Data for these patients was obtained from the Hiroshima University Hospital database.…”

“…21 Indeed, although Le Joncour et al reported that 10-year vascular event-free and amputation-free rates were 23% and 74%, respectively, in patients with TAO, there were only 3 unknown deaths reported (1.3%) and there was no cardiovascular death during long follow-up periods. 18 In addition, Guo et al reported that cell therapy improved the amputation-free survival rate over a 10-year follow-up period in Chinese patients with TAO who underwent BM-MNC implantations compared with the control group and that there were no deaths, major adverse cardiac events, or malignancy in the 2 groups during the follow-up period. 25 These findings suggest that increases in cardiovascular events, including limb amputation, are not related to the increase in mortality rate in TAO patients with and without cell therapy.…”

Smoking and the Pathophysiology of Peripheral Artery Disease

“…The simplest and most effective method to prevent further aggravation of this diseases is to stop smoking completely or use tobacco in any form (151,152). After the diagnosis of TAO, patients who stop smoking have a lower risk of amputation than those who continue to smoke (153).…”

The Imbalance among Oxidative Biomarkers and Antioxidant Defense Systems in Thromboangiitis Obliterans (Winiwarter-Buerger Disease)

“…Although the clinic-pathological hallmarks, and some molecular mechanisms have been studied, the etiology, pathophysiology, and optimal therapy remain not yet fully defined or understood [4]. Although a significant relationship between smoking (both tobacco and cannabis products) and progression of WBD has been identified [5], smoking per se cannot explain the prevalence and distribution of this harmful vascular disease [6]. Despite efforts in previous years and advances in medical therapy [4,7,8], WBD patients may actually benefit only by blocking smoking habits (abstinence of all tobacco/cannabis product use) and through targeted endovascular therapy, effective for preserving limb loss/amputation, and useful for accelerating the healing process in Buerger's ischemic ulcers [9].…”