Immediate and late outcomes of endovascular therapy for lower extremity arteries in Buerger disease

Dae Hoon Kim, Young Guk Ko, Chul Min Ahn, Dong Ho Shin, Jung Sun Kim, Byeong Keuk Kim, Donghoon Choi, Myeong Ki Hong, Yangsoo Jang

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: Buerger disease is a rare inflammatory vasculopathy presenting with severe claudication or critical limb ischemia. In this study, we sought to evaluate the feasibility and clinical outcomes of endovascular therapy for Buerger disease involving arteries in the lower extremities. Methods: Between January 2006 and May 2016, there were 44 Buerger disease patients (43 men; mean age, 40.4 ± 9.6 years) with 50 target limbs treated by endovascular therapy at the Severance Cardiovascular Hospital. Baseline characteristics as well as both immediate and late clinical outcomes were retrospectively analyzed. Results: The majority (86.4%) of patients presented with critical limb ischemia. A total of 88 target lesions in 50 limbs were treated with endovascular procedures. All limbs showed infrapopliteal artery occlusions, and multilevel diseases involving the iliac or femoropopliteal artery were found in 31 patients (62%). Technical success was achieved in 80% of subjects. We found that a lower serum level of C-reactive protein, specifically the log C-reactive protein value (odds ratio, 0.03; 95% confidence interval [CI], 0.00-0.71; P =.030), was an independent predictor of technical failure. The median follow-up duration was 29 months. Major adverse limb event-free survival and reintervention- and amputation-free survival were 83.3% and 67.9% at 3 years, respectively. In a multivariate Cox proportional hazards analysis, previous endovascular treatment (hazard ratio, 3.70; 95% CI, 1.20-11.31; P =.022) and previous amputation (hazard ratio, 4.68; 95% CI, 1.37-15.96; P =.014) were identified as independent risk factors for reintervention- and amputation-free survival. Conclusions: In patients with Buerger disease, endovascular treatment achieved technical success in the majority of the cases and was associated with favorable immediate and late clinical outcomes. These findings indicate that endovascular therapy may be considered a first-line treatment option for severe symptomatic patients with Buerger disease.

Original languageEnglish
Pages (from-to)1769-1777
Number of pages9
JournalJournal of Vascular Surgery
Volume67
Issue number6
DOIs
Publication statusPublished - 2018 Jun

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Thromboangiitis Obliterans
Lower Extremity
Extremities
Arteries
Amputation
Confidence Intervals
C-Reactive Protein
Therapeutics
Ischemia
Endovascular Procedures
Survival
Disease-Free Survival
Odds Ratio
Serum

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Kim, Dae Hoon ; Ko, Young Guk ; Ahn, Chul Min ; Shin, Dong Ho ; Kim, Jung Sun ; Kim, Byeong Keuk ; Choi, Donghoon ; Hong, Myeong Ki ; Jang, Yangsoo. / Immediate and late outcomes of endovascular therapy for lower extremity arteries in Buerger disease. In: Journal of Vascular Surgery. 2018 ; Vol. 67, No. 6. pp. 1769-1777.
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abstract = "Objective: Buerger disease is a rare inflammatory vasculopathy presenting with severe claudication or critical limb ischemia. In this study, we sought to evaluate the feasibility and clinical outcomes of endovascular therapy for Buerger disease involving arteries in the lower extremities. Methods: Between January 2006 and May 2016, there were 44 Buerger disease patients (43 men; mean age, 40.4 ± 9.6 years) with 50 target limbs treated by endovascular therapy at the Severance Cardiovascular Hospital. Baseline characteristics as well as both immediate and late clinical outcomes were retrospectively analyzed. Results: The majority (86.4{\%}) of patients presented with critical limb ischemia. A total of 88 target lesions in 50 limbs were treated with endovascular procedures. All limbs showed infrapopliteal artery occlusions, and multilevel diseases involving the iliac or femoropopliteal artery were found in 31 patients (62{\%}). Technical success was achieved in 80{\%} of subjects. We found that a lower serum level of C-reactive protein, specifically the log C-reactive protein value (odds ratio, 0.03; 95{\%} confidence interval [CI], 0.00-0.71; P =.030), was an independent predictor of technical failure. The median follow-up duration was 29 months. Major adverse limb event-free survival and reintervention- and amputation-free survival were 83.3{\%} and 67.9{\%} at 3 years, respectively. In a multivariate Cox proportional hazards analysis, previous endovascular treatment (hazard ratio, 3.70; 95{\%} CI, 1.20-11.31; P =.022) and previous amputation (hazard ratio, 4.68; 95{\%} CI, 1.37-15.96; P =.014) were identified as independent risk factors for reintervention- and amputation-free survival. Conclusions: In patients with Buerger disease, endovascular treatment achieved technical success in the majority of the cases and was associated with favorable immediate and late clinical outcomes. These findings indicate that endovascular therapy may be considered a first-line treatment option for severe symptomatic patients with Buerger disease.",
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Immediate and late outcomes of endovascular therapy for lower extremity arteries in Buerger disease. / Kim, Dae Hoon; Ko, Young Guk; Ahn, Chul Min; Shin, Dong Ho; Kim, Jung Sun; Kim, Byeong Keuk; Choi, Donghoon; Hong, Myeong Ki; Jang, Yangsoo.

In: Journal of Vascular Surgery, Vol. 67, No. 6, 06.2018, p. 1769-1777.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Immediate and late outcomes of endovascular therapy for lower extremity arteries in Buerger disease

AU - Kim, Dae Hoon

AU - Ko, Young Guk

AU - Ahn, Chul Min

AU - Shin, Dong Ho

AU - Kim, Jung Sun

AU - Kim, Byeong Keuk

AU - Choi, Donghoon

AU - Hong, Myeong Ki

AU - Jang, Yangsoo

PY - 2018/6

Y1 - 2018/6

N2 - Objective: Buerger disease is a rare inflammatory vasculopathy presenting with severe claudication or critical limb ischemia. In this study, we sought to evaluate the feasibility and clinical outcomes of endovascular therapy for Buerger disease involving arteries in the lower extremities. Methods: Between January 2006 and May 2016, there were 44 Buerger disease patients (43 men; mean age, 40.4 ± 9.6 years) with 50 target limbs treated by endovascular therapy at the Severance Cardiovascular Hospital. Baseline characteristics as well as both immediate and late clinical outcomes were retrospectively analyzed. Results: The majority (86.4%) of patients presented with critical limb ischemia. A total of 88 target lesions in 50 limbs were treated with endovascular procedures. All limbs showed infrapopliteal artery occlusions, and multilevel diseases involving the iliac or femoropopliteal artery were found in 31 patients (62%). Technical success was achieved in 80% of subjects. We found that a lower serum level of C-reactive protein, specifically the log C-reactive protein value (odds ratio, 0.03; 95% confidence interval [CI], 0.00-0.71; P =.030), was an independent predictor of technical failure. The median follow-up duration was 29 months. Major adverse limb event-free survival and reintervention- and amputation-free survival were 83.3% and 67.9% at 3 years, respectively. In a multivariate Cox proportional hazards analysis, previous endovascular treatment (hazard ratio, 3.70; 95% CI, 1.20-11.31; P =.022) and previous amputation (hazard ratio, 4.68; 95% CI, 1.37-15.96; P =.014) were identified as independent risk factors for reintervention- and amputation-free survival. Conclusions: In patients with Buerger disease, endovascular treatment achieved technical success in the majority of the cases and was associated with favorable immediate and late clinical outcomes. These findings indicate that endovascular therapy may be considered a first-line treatment option for severe symptomatic patients with Buerger disease.

AB - Objective: Buerger disease is a rare inflammatory vasculopathy presenting with severe claudication or critical limb ischemia. In this study, we sought to evaluate the feasibility and clinical outcomes of endovascular therapy for Buerger disease involving arteries in the lower extremities. Methods: Between January 2006 and May 2016, there were 44 Buerger disease patients (43 men; mean age, 40.4 ± 9.6 years) with 50 target limbs treated by endovascular therapy at the Severance Cardiovascular Hospital. Baseline characteristics as well as both immediate and late clinical outcomes were retrospectively analyzed. Results: The majority (86.4%) of patients presented with critical limb ischemia. A total of 88 target lesions in 50 limbs were treated with endovascular procedures. All limbs showed infrapopliteal artery occlusions, and multilevel diseases involving the iliac or femoropopliteal artery were found in 31 patients (62%). Technical success was achieved in 80% of subjects. We found that a lower serum level of C-reactive protein, specifically the log C-reactive protein value (odds ratio, 0.03; 95% confidence interval [CI], 0.00-0.71; P =.030), was an independent predictor of technical failure. The median follow-up duration was 29 months. Major adverse limb event-free survival and reintervention- and amputation-free survival were 83.3% and 67.9% at 3 years, respectively. In a multivariate Cox proportional hazards analysis, previous endovascular treatment (hazard ratio, 3.70; 95% CI, 1.20-11.31; P =.022) and previous amputation (hazard ratio, 4.68; 95% CI, 1.37-15.96; P =.014) were identified as independent risk factors for reintervention- and amputation-free survival. Conclusions: In patients with Buerger disease, endovascular treatment achieved technical success in the majority of the cases and was associated with favorable immediate and late clinical outcomes. These findings indicate that endovascular therapy may be considered a first-line treatment option for severe symptomatic patients with Buerger disease.

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