Revascularization for lower limbs thromboangiitis obliterans-early and mid-term outcome report / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVES</b>To summarize the outcome of revascularization for lower limbs thromboangiitis obliterans (TAO) and evaluate risk factors affected outcomes.</p><p><b>METHODS</b>Between January 2008 and December 2011, a consecutive series of 24 TAO patients with lower limb ischemia were underwent revascularization. All the patients were male. The mean age was (33 ± 6) years (24-43 years). All patients presented with history of heavy smoking.Fifteen patients (62.5%) presented with ulcer or gangrene, 7 cases (29.2%) presented with rest pain, the rest 2 cases (8.3%) presented with severe intermittent claudication.Eight cases underwent bypass, including 6 autogenous vein graft, 1 prosthesis graft and 1 hybrid graft; 7 cases underwent catheter-directed thrombolysis combined with angioplasty; 3 cases underwent angioplasty and stenting directly; the rest 6 cases underwent thromboectomy and/or endarterectomy. The technical success, amputation and patency of target vessel were reported.Some risk factors were evaluated by multi-factors regression analysis to identify whether influenced outcomes.</p><p><b>RESULTS</b>Seventeen cases (70.8%) harvested primary technical success. Three cases (12.5%) suffered with major amputation due to failure of revascularization.Eight cases with bypass all were successful, 4 cases with thrombolysis got success, 2 cases with primary angioplasty and stenting got success, while the 3 cases with thromboemctomy and/or endarterectomy got success. Among the 7 failed cases, 3 cases needed major amputation, 2 cases underwent re-operation, and the rest 2 cases got conservation treatment. All the patients had effective follow-up between 1 and 40 months (mean (17 ± 11) months).No death occurred during the follow-up. Primary patency, secondary patency and limb salvage rate were 45.8% (11/24), 62.5% (15/24), and 79.2% (19/24), respectively.Risk factors regression analysis showed patients with ulcer or gangrene before revascularization got significant worse outcomes (Wald = 4.018, P = 0.043) . Bypass could improve outcomes significantly (Wald = 4.016, P = 0.045) .</p><p><b>CONCLUSIONS</b>Outcomes of revascularization for TAO with lower limb severe ischemia are acceptable. Autogenous vein graft bypass should be first choice. Thrombolysis with angioplasty could be a reasonable choice for those had no satisfied autogenous vein graft.</p>