Short-term efficacy of endovascular procedures for lower extremity thromboangiitis obliterans (Buerger’s disease)

ABSTRACT

Purpose

Although thrombolysis obliterans (TAO) has been recognized for more than a century, there is no optimal treatment for this disease. The aim of this report was to compare the short-term efficacies of catheter-directed thrombolysis (CDT), percutaneous transluminal angioplasty (PTA) and CDT+PTA in treating TAO disease.

Method

Consecutive patients with TAO treated at Ganzhou People’s Hospital between 2012 and 2022 were included in this retrospective study. According to the information provided in the medical records, endovascular procedures included CDT, PTA or CDT+PTA. One-year follow-up outcomes of the patients with TAO who underwent endovascular procedures were compared. The primary outcome was major adverse limb event (MALE) and the secondary outcomes were the technical success, complications, ABI at 1 week after surgery and minor amputation.

Results

Sixty-nine patients with TAO were assessed for inclusion in our single-center study from 2012 to 2022 and received endovascular procedures. Among them, 22 patients underwent CDT, 21 patients underwent PTA, and 26 patients underwent PTA+CDT. The one-year follow-up revealed significant differences in the MALE-free survival rates among the three groups, particularly between the CDT group and the PTA+CDT group (the hazard ratio (HR) for MALE-free survival was 0.173, 95% CI [0.050–0.599], p = 0.006). The technical success rates of the three groups were 63.6%, 90.5%, and 92.3%, respectively. There were differences in the ABI at one week after surgery among the three groups.

Conclusions

Endovascular procedures are effective for TAO in the short term. The effectiveness of CDT alone is suboptimal; combining CDT with PTA achieves the most favorable endovascular treatment outcome; while the effectiveness of PTA falls in between these two procedures.

KEYWORDS:

• Lower extremity
• thromboangiitis obliterans
• Buerger’s disease
• endovascular procedures
• Thrombolysis
• Angioplasty

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. A reviewer on this manuscript has disclosed being a consultant and research grant recipient of Boston Scientific. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Acknowledgments

The authors thank the American Journal Experts (AJE) for the English polishing of the paper.

Author contributions

GFZ and XCL conceived the study, made the design, performed the statistical analyses, and drafted the manuscript. GFZ and XCL participated in the design and statistic work. HLX and MGL collected data. HLX and XCL revised the paper. All authors gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

Ethics statement

This study was approved by the ethics committee and institutional review board of the Ganzhou People’s Hospital and the ethics board approval number was TY-ZKY2024-012-01. Written informed consent was obtained from all the subjects involved in the study.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author XCL. The data are not publicly available due to the containing information that could compromise the privacy of research participants.

Additional information

Funding

This study was supported by the Science and Technology Program of Jiangxi Health Commission [No: 202410094].