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.

« Back to ACR/ARHP Annual Meeting 2016

ACR Meeting Abstracts - https://acrabstracts.org/abstract/thromboangiitis-obliterans-buergers-disease-an-observational-study-of-174-patients/