Vascular reconstruction in Buerger's disease

Shionoya, Shigehiko; Ban, Ichiro; Nakata, Yusuke; Matsubara, Junichi; Harada, Masafumi

doi:10.1002/bjs.1800631102

Cited by 25 publications

(11 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Contrary to this it seems that vascular surgeons in Asia are more often confronted with this clinical problem and therefore included surgical bypasses very early in their therapeutic concept [7]. They reported satisfying clinical results in those patients who remained non-smokers [17].…”

Section: Discussionmentioning

confidence: 99%

“…Hence previous infl ammation of the superfi cial veins often limits their availability as bypass grafts. However surgical vein bypass was recommended by Asian groups and a few European groups as an eff ective therapy for critical ischaemia [5][6][7][8][9]. The results of a contemporary series of patients with TAO treated with distal vein bypass after cessation of smoking are evaluated.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Very distal vein bypass in patients with thromboangiitis obliterans

Neufang

Vargas-Gomez

Ewald

et al. 2017

Vasa

View full text Add to dashboard Cite

Summary:Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex fi ndings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin confi guration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superfi cial femoral artery was used for infl ow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identifi ed graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after defi nitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.Keywords: Thromboangiitis obliterans, bypass, limb salvage, human, vascular patency ease frequently involves the small distal arteries of the calf and the foot with complete obliteration of the vessel lumen and absence of a suitable distal artery for bypass. The angiographic pattern of TAO is characterized by occlusions of the tibial and pedal arteries and the presence of typical corkscrew collaterals with normal proximal arteries [2,3]. Surgical revascularization with autologous vein bypass is rarely regarded as feasible due to the absence of healthy distal arterial segments or because of the small calibre of patent arteries and recent advances in conservative treatment. Superfi cial veins may become aff ected by the disease in form of phlebitis migrans with consecutive infl ammatory changes [4]. Hence previous infl ammation of the superfi cial veins often limits their availability as bypass grafts. However surgical vein bypass was recommended by Asian groups and a few European groups as an eff ective therapy for critical ischaemia [5][6][7][8][9]. The results of a contemporar...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Very distal vein bypass in patients with thromboangiitis obliterans

Neufang

Vargas-Gomez

Ewald

et al. 2017

Vasa

View full text Add to dashboard Cite

show abstract

“…This is the reason why there are only few reported series in the literature. [3][4][5] The largest series of revascularization procedures in Buerger's disease belongs to Ohta and Shionoya.6 They revascularized 74 lower limbs in 69 patients in a group consisting of 328 patients during the years 1968 to 1985. Early and late graft failures were recognized in 22 and 21 patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…These types of occlusions are rarely encountered, and for this reason there are only a few reported series in the literature. [3][4][5][6] Materials and Methods During the last six years, from January, 1984, to January 1990, 132 patients with Buerger's disease were admitted to the Department of Thoracic and Cardiovascular Surgery, Istanbul University Cerrahpasa Medical Faculty. All patients except 1 were men with an age range of nineteen to fifty-nine years (mean 36.3 years).…”

Section: Introductionmentioning

confidence: 99%

Direct Arterial Reconstruction in Buerger's Disease

et al. 1992

View full text Add to dashboard Cite

During the last six years the authors surgically treated 132 patients with Buerger's disease. They were able to perform arterial reconstruction in 14. Nonhealing ulcers and impending gangrene were the most frequent indications (62.2%).The type and number of surgical procedures were as follows: aorto femoral (1), iliofemoral (2), femoropopiteal (3), femorocrural (3), by-passes and thromboendarterectomy with patch angioplasty (5). There were no perioperative or postoperative deaths. Early thrombosis occurred in 3 patients. Of the 11 patients with patent arterial reconstructions, 3 showed occlusion within the first year. The cumulative patency rate was 57%.Although the patency rates for direct arterial surgery in Buerger's disease are not as good as those reported for arteriosclerosis obliterans, the authors believe that, in appropriate cases, arterial reconstructive procedures should be tried to achieve better healing of the trophic lesions without major amputation.

show abstract

“…At the present time sympathectomy is usually considered after failure of medical treatment before or as-sociated with an amputation. Shionoya (11) reported success in revasculariza-tion in patients with thromboangiitis. In most instances, bypass procedures are impractical or long term success are poor because a poor sites for the distal anastomosis and poor distal runoff.…”

Section: Treatmentmentioning

confidence: 99%

Juvenile arteritis revisited

Fiessinger

2002

Pathophysiol Haemos Thromb

View full text Add to dashboard Cite

Vascular reconstruction in Buerger's disease

Cited by 25 publications

References 11 publications

Very distal vein bypass in patients with thromboangiitis obliterans

Very distal vein bypass in patients with thromboangiitis obliterans

Direct Arterial Reconstruction in Buerger's Disease

Juvenile arteritis revisited

Contact Info

Product

Resources

About