Thromboangiitis Obliterans (Buerger’s disease) : An Observational Study of 174 Patients

Alexandre LE JONCOUR¹, Simon Soudet², Hélène Maillard², Fabien Koskas³, Philippe Cluzel⁴, Eric Hachulla⁵, Pierre-Yves Hatron⁵, Patrice Cacoub¹, Marc Lambert² and David Saadoun¹, ¹Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et d’Immunologie clinique, DHU i2B, Inflammation, Immunopathologie, Biothérapie, Université Pierre et Marie Curie, Paris 6, Paris, France, Paris, France, ²Department of internal medecine, Hôpital Claude Huriez, CHRU Lille, France, Lille, France, ³Department of vascular surgery, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France, ⁴Department of cardiovascular imagery, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié Salpétrière, 83 Boulevard de l'Hôpital, 75013, Paris, France., Paris, France, ⁵CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France, Lille, France

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Thrombosis, tobacco use and vasculitis

Session Information

Date: Tuesday, November 15, 2016

Title: Vasculitis - Poster III: Rarer Vasculitides

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Buerger’s disease or thromboangiitis obliterans (TAO) is a nonatherosclerotic segmental inflammatory disease of small- and medium-sized arteries of the distal extremities. This disease mainly affect young male tobacco users but the pathophysiology remains unknown. Most series of TAO come from India and Japan. Herein, we aim report to describe clinical presentation, treatment and long-term outcome in a large cohort of TAO.

Methods: We reviewed the charts of 174 [136 (78,2%) male, sex ratio 3.7, mean age at diagnosis of 38,4 years] consecutive french patients with TAO criteria from two french university center of internal medicine diagnosed between 1967 to 2015.

Results: The mean time between onset of symptoms and diagnosis was of 2.5 ±0.7years. One hundred seventy one (98.3%) patients were tobacco users with a mean consumption of 23.4 pack-years and 34 (19.5%) were cannabis consumers. At diagnosis, 15 patients (8.7%) had deep vein thrombosis, 39 (22.5%) superficial vein thrombosis, 76 (43.9%) Raynaud’s phenomenon and 14 (8%) arthralgia. Ischaemia of lower limbs, upper limbs and upper-lower limb were found in 98/173 (56.6%), 44/173 (25.4%) and in 18/173 (10.4%) patients, respectively. After a median follow-up of 3 (IQ25 :1 ; IQ 75 8,8) years, 89/171 (52%) had stopped their tobacco consumption and 26/34 (78.8%) their cannabis consumption. One hundred patients (57.4%) were treated by aspirin alone, 33(19%) by clopidogrel alone and 33 (19%) with both treatment. Ninety five (54.6%) had statins, 53 (30.5%) calcic inhibitors, 91 (52.3%) oral vasodilatators, 28 (16.1%) conversion enzyme inhibitors and 117 patients (67.2%) received at least one infusion of ilomedine. Forty five patients (25.9%) had at least one vascular intervention and 12/45 (26.7%) had an amputation. At the end of follow up, 104/169 patients (61.5%) were asymptomatic, 140/174 (80.5%) were amputation free. Among patient with amputation, 15/34 (44.1%) patients had more than one amputation. Mean time between diagnosis and first amputation was of 2.5 years. Two patients died at the end of folow-up.

Conclusion: TAO is a rare vasculitis, with few data coming from western countries. Functional prognosis is very poor with up to 20% of amputation at 3 years.

Disclosure: A. LE JONCOUR, None; S. Soudet, None; H. Maillard, None; F. Koskas, None; P. Cluzel, None; E. Hachulla, None; P. Y. Hatron, None; P. Cacoub, None; M. Lambert, None; D. Saadoun, None.

To cite this abstract in AMA style:

LE JONCOUR A, Soudet S, Maillard H, Koskas F, Cluzel P, Hachulla E, Hatron PY, Cacoub P, Lambert M, Saadoun D. Thromboangiitis Obliterans (Buerger’s disease) : An Observational Study of 174 Patients [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/thromboangiitis-obliterans-buergers-disease-an-observational-study-of-174-patients/. Accessed .

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