ROLE OF INFRAINGUINAL BYPASS IN BUERGERS-DISEASE - AN 18-YEAR EXPERIENCE

Objectives: The role of bypass to the distal arteries for patients wit h Buerger's disease (thromboangiitis or TAO) remains controversial bec ause of the high incidence of graft failure. We retrospectively review ed the results of 71 bypasses to evaluate their efficacy. Materials an d methods: We performed 71 autogenous vein bypasses in 61 patients, 97 % were heavy smokers. The indications for surgery were claudication in 41%, and ischaemic ulcer or gangrene in 59%. Of the bypasses 85% were to the crural arteries or to the arteries below the ankle. The grafts used were 53 single saphenous veins, and 18 venovenous composite graf ts. Results: There were 38 graft failures, the main causes including a nastomosis to a diseased artery, disease progression (which occurred i n smokers after surgery), and vein graft stenosis. Of 38, 10 were rest ored to patency by revision surgery. Primary and secondary patency rat es were 48.8% and 62.5% at 5 years, and 43.0% and 56.3% at 10 years, r espectively. The patency rates of the postoperative non-smoking group was significantly higher than that of the smoking group (66.8% vs. 34. 7%, p < 0.05). Thirty-six patients (59%) had successful revascularisat ion and returned to full-time work. However, of 28 with secondary fail ure, 11 underwent amputation, while 14 had persistent disabling claudi cation. Conclusion: Bypass to the distal arteries is an effective trea tment for TAO patients, and the long-term patency is quite satisfactor y as long as patients stop smoking.