The change in concept and surgical treatment on Buerger's disease--personal experience and review.

Buerger's disease was originally described by Leo Buerger in 1908 as thromboangitis obliterance and has been considered as one of the most intractable vasculitis syndromes in our country. This lesion is popularly seen in male young generation with a background history of heavy smoking. Buerger's disease in Japan has been frequently seen in our practice; however, it is noted that there have been certain definitive changes in relation to number of patients, clinical manifestation as well as course of treatment in particular in surgical treatment. Firstly, the number of patients who visited at outpatient clinic as well as to admit hospital has been sharply declined. Secondly, the number of surgical treatments of Buerger's disease have also decreased. The sympathectomy, mainly lumbal sympathectomy, which was maintained at about 15 to 20% of the number of patients admitted, was virtually abolished from the practice and mainly converted to the medical and pharmacological treatment by prostaglandin. The reliability of pharmacological sympathectomy is one of the other reasons which contributed to the shift of treatment. It is also our impression that the severity of the disease itself has been changed, in other words, we do not frequently see very severely ill patients. As far as surgery is concerned the important modality in the treatment for the advanced lesion of Buerger's disease is mainly confined in small arteries with multisegmental occlusion. As a consequence, the surgical reconstructive procedures are technically difficult and long term patency rate is considered to be low. As far as our experience is concerned, it is noted that the number of bypass surgery was most frequently seen at below trifurcation segment of knee joint; in other words, peripheral, distal type bypass was the most popular, followed by above knee segment. The reconstructive surgery at femoral region was least frequently seen. On the other hand, the patency rate of bypass graft was higher in the proximal segment in comparison to the distal segment. Although the number of arterial reconstructive procedures has been definitively declined, as was seen in sympathectomy surgery. It is difficult to predict accurately what kind of factors are affecting or contributing to the change in concept in Buerger's disease as well as the course of treatment, it is suggested that the environmental factors may playing a major role for the modification of disease process.