Buerger's disease surgery: Difference between revisions
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===Revascularization=== | ===Revascularization=== | ||
*The mainstay of treatment for Buerger's disease is smoking cessation. | *The mainstay of treatment for Buerger's disease is smoking cessation.<ref name="pmid21944922">{{cite journal |vauthors=Lee T, Ra HD, Park YJ, Park HS, Kim SJ |title=New routing alternative for proximal anterior tibial artery bypass in patients with Buerger disease |journal=J. Vasc. Surg. |volume=54 |issue=6 |pages=1839–41 |date=December 2011 |pmid=21944922 |doi=10.1016/j.jvs.2011.06.111 |url=}}</ref><ref name="pmid8076063">{{cite journal |vauthors=Sayin A, Bozkurt AK, Tüzün H, Vural FS, Erdog G, Ozer M |title=Surgical treatment of Buerger's disease: experience with 216 patients |journal=Cardiovasc Surg |volume=1 |issue=4 |pages=377–80 |date=August 1993 |pmid=8076063 |doi= |url=}}</ref><ref name="pmid9091153">{{cite journal |vauthors=Sasajima T, Kubo Y, Inaba M, Goh K, Azuma N |title=Role of infrainguinal bypass in Buerger's disease: an eighteen-year experience |journal=Eur J Vasc Endovasc Surg |volume=13 |issue=2 |pages=186–92 |date=February 1997 |pmid=9091153 |doi= |url=}}</ref> | ||
*Bypass surgery may be an appropriate intervention in those with severe ischemia. | *Bypass surgery may be an appropriate intervention in those with severe ischemia. | ||
*An autologous vein or an omental graft is often used to save compromised limbs. | *An autologous vein or an omental graft is often used to save compromised limbs. | ||
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===Endovascular intervention=== | ===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. | Thrombolytic therapy with low dose intra-arterial streptokinase has been found to improve the chances of limb salvage in gangrenous or pre-gangrenous limbs.<ref name="pmid22285343">{{cite journal |vauthors=Graziani L, Morelli L, Parini F, Franceschini L, Spano P, Calza S, Sigala S |title=Clinical outcome after extended endovascular recanalization in Buerger's disease in 20 consecutive cases |journal=Ann Vasc Surg |volume=26 |issue=3 |pages=387–95 |date=April 2012 |pmid=22285343 |doi=10.1016/j.avsg.2011.08.014 |url=}}</ref><ref name="pmid8473086">{{cite journal |vauthors=Hussein EA, el Dorri A |title=Intra-arterial streptokinase as adjuvant therapy for complicated Buerger's disease: early trials |journal=Int Surg |volume=78 |issue=1 |pages=54–8 |date=1993 |pmid=8473086 |doi= |url=}}</ref> | ||
===Sympathectomy and spinal cord stimulation=== | ===Sympathectomy and spinal cord stimulation=== | ||
Lumbar and thoracic sympathectomy, and spinal cord stimulation may be performed to control pain symptoms. | Lumbar and thoracic sympathectomy, and spinal cord stimulation may be performed to control pain symptoms.<ref name="pmid9152156">{{cite journal |vauthors=Lau H, Cheng SW |title=Buerger's disease in Hong Kong: a review of 89 cases |journal=Aust N Z J Surg |volume=67 |issue=5 |pages=264–9 |date=May 1997 |pmid=9152156 |doi= |url=}}</ref><ref name="pmid10231644">{{cite journal |vauthors=Swigris JJ, Olin JW, Mekhail NA |title=Implantable spinal cord stimulator to treat the ischemic manifestations of thromboangiitis obliterans (Buerger's disease) |journal=J. Vasc. Surg. |volume=29 |issue=5 |pages=928–35 |date=May 1999 |pmid=10231644 |doi= |url=}}</ref><ref name="pmid12429549">{{cite journal |vauthors=Pace AV, Saratzis N, Karokis D, Dalainas D, Kitas GD |title=Spinal cord stimulation in Buerger's disease |journal=Ann. Rheum. Dis. |volume=61 |issue=12 |pages=1114 |date=December 2002 |pmid=12429549 |pmc=1753958 |doi= |url=}}</ref> | ||
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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, 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, 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.
- 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 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.