Clinical and social consequences of Buerger disease.

ABSTRACT

PURPOSE: This study was undertaken to assess the clinical course of Buerger disease and to analyze the social problems that influence quality of life of affected patients. PATIENTS AND METHODS: One hundred ten patients with Buerger disease (106 men, 4 women; mean age, 40.0 years) for whom complete data since onset of disease were available were included in this retrospective study (mean follow-up, 10.6 years). Data were obtained by means of direct interview, written reports, or telephone. Data for deceased subjects were gathered from their families via written report or telephone. Graft patency was evaluated by means of ankle pressure measurement; and in all patients with decreased ankle pressure arteriography was performed. RESULTS: Seven of 110 study patients (6%) died during follow-up. Cumulative survival rate was 84% up to 25 years after the initial consultation. Results of bypass operations (n = 46) were not satisfactory. Primary graft patency was 41% at 1 year after operation, 32% at 5 years, and 30% at 10 years. Secondary graft patency was 54% at 1 year of follow-up, 47% at 5 years, and 39% at 10 years. However, major amputation was necessary in only 5 of 35 limbs (14%) with failed grafts. Forty-seven patients (43%) underwent 108 amputation procedures, either major amputation (13 patients) or minor amputation (34 patients), of an upper or lower limb. No ischemic ulcers occurred or recurred in patients older than 60 years. Forty-one patients who stopped smoking did not undergo major amputation. Furthermore, of 69 patients who continued smoking, 13 patients (19%) underwent major amputation. There was a correlation between incidence of continued smoking and limb amputation (P =.0070). In addition, 11 of 13 patients who underwent major lower limb amputation (85%) lost their job, compared with 9 of 97 patients without major amputation (9%). There was an association between limb amputation and job loss (P <.0001). All patients who lost their jobs were engaged in manual labor. CONCLUSION: The natural course of life and limb is favorable in many patients with Buerger disease. Occurrence or recurrence of necrotic lesions usually is arrested in patients older than 60 years. To avoid factors that markedly influence quality of life, early treatment and strict instruction to prohibit smoking are mandatory. Arterial reconstruction shortens the healing process of ischemic ulcers, despite poor long-term results. However, bypass surgery to treat intermittent claudication should be limited.