Buerger's disease surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Surgery is usually not feasible in Buerger's disease since the integrity of the distal vessels usually does not allow for revascularization, nevertheless, surgical intervention may be considered in order to maintain peripheral blood flow as much possible. Surgical intervention may also be carried out in order to provide pain relief, heal ulcers and decrease the chances of future amputations, such as sympathectomy.
Surgery
Surgery is usually not feasible in Buerger's disease since the integrity of the distal vessels usually does not allow for revascularization, nevertheless, surgical intervention may be considered in order to maintain peripheral blood flow as much possible. Surgical intervention may also be carried out in order to provide pain relief, heal ulcers and decrease the chances of future amputations, such as sympathectomy.
Revascularization
- The mainstay of treatment for Buerger's disease is smoking cessation.[1][2][3]
- Bypass surgery may be an appropriate intervention in those with severe ischemia and target vessels.
- An autologous vein or an omental graft is often used to save compromised limbs.
- Grafts may also be used to treat non-healing ulcers in those who have abstained from smoking.
Endovascular intervention
- Thrombolytic therapy with low dose intra-arterial streptokinase has been found to improve the chances of limb salvage in gangrenous or pre-gangrenous limbs.[4][5]
Sympathectomy and spinal cord stimulation
- Lumbar and thoracic sympathectomy, and spinal cord stimulation may be performed to heal ulcers and control pain symptoms.[6][7][8]
References
- ↑ Lee T, Ra HD, Park YJ, Park HS, Kim SJ (December 2011). "New routing alternative for proximal anterior tibial artery bypass in patients with Buerger disease". J. Vasc. Surg. 54 (6): 1839–41. doi:10.1016/j.jvs.2011.06.111. PMID 21944922.
- ↑ Sayin A, Bozkurt AK, Tüzün H, Vural FS, Erdog G, Ozer M (August 1993). "Surgical treatment of Buerger's disease: experience with 216 patients". Cardiovasc Surg. 1 (4): 377–80. PMID 8076063.
- ↑ Sasajima T, Kubo Y, Inaba M, Goh K, Azuma N (February 1997). "Role of infrainguinal bypass in Buerger's disease: an eighteen-year experience". Eur J Vasc Endovasc Surg. 13 (2): 186–92. PMID 9091153.
- ↑ Graziani L, Morelli L, Parini F, Franceschini L, Spano P, Calza S, Sigala S (April 2012). "Clinical outcome after extended endovascular recanalization in Buerger's disease in 20 consecutive cases". Ann Vasc Surg. 26 (3): 387–95. doi:10.1016/j.avsg.2011.08.014. PMID 22285343.
- ↑ Hussein EA, el Dorri A (1993). "Intra-arterial streptokinase as adjuvant therapy for complicated Buerger's disease: early trials". Int Surg. 78 (1): 54–8. PMID 8473086.
- ↑ Lau H, Cheng SW (May 1997). "Buerger's disease in Hong Kong: a review of 89 cases". Aust N Z J Surg. 67 (5): 264–9. PMID 9152156.
- ↑ Swigris JJ, Olin JW, Mekhail NA (May 1999). "Implantable spinal cord stimulator to treat the ischemic manifestations of thromboangiitis obliterans (Buerger's disease)". J. Vasc. Surg. 29 (5): 928–35. PMID 10231644.
- ↑ Pace AV, Saratzis N, Karokis D, Dalainas D, Kitas GD (December 2002). "Spinal cord stimulation in Buerger's disease". Ann. Rheum. Dis. 61 (12): 1114. PMC 1753958. PMID 12429549.