Long-term outcomes of endovascular therapy in Buerger disease with critical limb ischemia: a retrospective observational study

Buerger disease, or thromboangiitis obliterans (TAO), is a rare non-atherosclerotic vasculitis affecting distal vessels, often resulting in critical limb ischemia (CLI). Endovascular therapy (EVT) has emerged as a potential treatment, though long-term data remain limited. This study evaluates outcomes and survival predictors following EVT in patients with TAO-related CLI.

A retrospective cohort of 100 patients with angiographic features consistent with thromboangiitis obliterans and critical limb ischemia was analysed, including a subgroup of patients fulfilling strict Shionoya/Olin criteria (definite TAO) and a subgroup with TAO-like angiographic patterns but coexisting atherosclerotic risk factors. Primary outcomes were technical success and limb salvage. Secondary endpoints included amputation-free survival, ulcer healing, reintervention, and vessel patency. Kaplan-Meier analysis assessed survival, with P<0.05 considered significant.

Mean age was 41.5±6.9 years; 51% were female, and 64% were current smokers. EVT included stenting (38%), drug-coated (31%), and plain balloon angioplasty (31%). Technical success was 92%. Limb salvage was achieved in 47%; amputation-free survival at 12 months was 51%. Kaplan-Meier analysis showed significantly longer survival in younger patients (≤40 years), never smokers, and those with ulcer healing, limb salvage, and vessel patency (all P<0.05). No significant differences were found by sex, diagnostic criteria, or reintervention.

EVT is a viable option in TAO-related CLI, with improved outcomes linked to younger age, smoking cessation, and ulcer healing. Despite high amputation rates, targeted intervention and follow-up may improve long-term limb preservation.