Factors affecting the long-term outcome of Buerger's disease (thromboangiitis obliterans).

BACKGROUND Although the age at onset in patients with Buerger's disease is relatively young, the life expectancy has been seldom reported in detail. The aim of this study is to study long-term results of Buerger's disease and factors affecting the ultimate outcome. METHODS From 1965 to 1980, 682 patients with Buerger's disease were treated in our outpatient department. We studied their long-term status, including concomitant diseases, and the disease progression by mail. RESULTS Of the 287 mail responders, 266 were male and 21 were female, with a mean age of 60 years. One hundred and fifty-five of these patients are currently suffering from clinical symptoms. Forty-eight patients underwent minor amputation and 30 and major amputation. Forty-six patients underwent sympathectomy, and only 17 bypass reconstruction. Although there was no significant difference in the continuation of symptoms between current smokers and ex-smokers, the amputation rate was higher in current smokers and continuous smoking is closely related to both minor and major amputations after sympathectomy and to minor amputations after drug therapy. Arteriosclerotic diseases were recognized in 57 patients, and gastroduodenal ulcer in 44. Thirty-three patients had died. Among 14 who died of neoplasm, three died of esophageal cancer and lung cancer, respectively, which were closely related to smoking. CONCLUSIONS The natural history of the limbs in patients with Buerger's disease is not completely discouraging, and in order to obtain a favourable outcome for patients with Buerger's disease we recommend complete smoking cessation with drug-therapy and surveillance for neoplasm, especially of the upper gastrointestinal tract and lung.