Kamphol Laohapensang
Nationality
Thailand
Current Position
Professor Emeritus / President
Organization
Thai Vascular Association (TVA)
Peripheral Artery Session

Topic: Current Status of Diagnosis and Treatment of Buerger's Disease

Abstract

The overall incidence of TAO appears to be decreasing in North America, Western Europe, South Asia, and Japan. A reduction in smoking among the general populations studied and the adoption of stricter diagnostic criteria may explain this decline over the past 4 decades.
A number of studies agree that tobacco use has a strong link to the pathogenesis and progression of TAO. Indeed, the only effective therapy for TAO is complete and permanent discontinuation of smoking. However, various medications, such as vasodilators (calcium channel blockers and prostaglandin analogues), anticoagulants, and thrombolytics, as well as noninvasive treatments, including intermittent pneumatic compression, have shown limited success for decreasing pain and avoiding amputation.
Invasive approaches, such as omental transfer and sympathectomy, have demonstrated promising short-term clinical improvement and low initial amputation rates but limited sustained, long-term symptomatic improvement.
Revascularization is the ideal treatment to reduce ischemic injuries; endovascular or surgical revascularization has often been difficult because of diseased distal runoff and diffuse segmental involvement and thrombotic nature of the disease of TAO. Surgical revascularization is rarely feasible, mainly due to distal arterial and venous involvement, lack of suitable target vessel, and absence of adequate vein conduit. Bypass surgery was carried out for less than 10% of surgically treated patients with TAO.
Since the majority of patients with CLI-are poor candidates for surgical bypass, we offer endovascular revascularization to patients with CLI or rapidly progressive limb-threatening disease, as well as those with recurrent or refractory symptoms who fail conservative management.
Endovascular approaches using various techniques should be considered for effective recanalization if a surgical treatment option is not available in patients with Buerger’s disease. It is also technically challenging because of the diffuse segmental involvement of small distal arteries.

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