Surgical treatment of Buerger's disease.

Forty of 266 patients with Buerger's disease underwent 47 vascular reconstructions: bypass in 38, thromboendarterectomy in 7 and replacement in 2. Indications for arterial reconstruction were ulceration or gangrene in 60%, claudication in 33.3% and rest pain in 6.7%. In a follow-up from 6 months to 8 years and 7 months, the overall patency rate was 24% in bypass, 0% in thromboendarterectomy and 100% in replacement. One hundred nine of the 266 patients underwent sympathetic denervation: lumbar in 92 (bilateral in 19) and thoracic in 17. In the course of 11 years follow-up study, 23 cases required amputation of the extremity. A good initial result gradually gave way to recurrence unless the patients discontinued smoking. The most important factor which decides natural history of Buerger's disease is smoking.