LONG-TERM FOLLOW-UP OF THROMBOANGIITIS-OBLITERANS

Background: To date there have been no clinical studies providing data on which to base a long-term medical and social prognosis of thromboa ngiitis obliterans (TAO). Against this background a retrospective inve stigation of the longterm course of patients with TAO, who attended th e vascular clinic in the medical department of the Klinikum Westend of the Freien Universitat Berlin (Free University of Berlin) or the Fran ziskus Hospital in Berlin was carried out during the period between 19 70 and 1990. Patients and methods: The 69 patients making up the overa ll group included 53 males and 16 females whose average age at the tim e of initial manifestation of TAO was 34 years. The mean interval betw een the initial manifestation of the disease and the follow up investi gation was 10.7 (range: 2-30) years. The assessment of the course over the long-term was based on a clinical follow-up survey or the data pr ovided by a questionnaire. Results: In 96% of the patients symptoms be gan in one of the lower limbs, predominantly in the forefoot. During t he further course of the illness, 73% of the patients developed sympto ms in at least one other limb, either upper or lower: Since the initia l development of symptoms, the patients had experienced an average of 5.4 (range: 1-20) acute attacks, that is, episodes of more severe symp toms. The most common reason for hospitalisation was necrosis of the l ower limbs, the usual site being the forefoot with primary involvement of the big toe in 57% of the cases. The mean duration of hospitalisat ion per hospital stay was 36.8 (range: 1-210) days. During the course of the disease 54 (78.2%) of the patients required an average of 3.7 ( range: 1-17) operations, 40 (74%) undergoing one or more amputations. Most of the amputations were performed during the first five years aft er disease onset and the amputation rate was 26%. With the exception o f a single lady, all the patients were smokers, and 40 (83.5%) of 48 s mokers for whom the relevant information was available persisted with their habit after the onset of the disease. 8 (16.6%) of the 48 patien ts claimed to have stopped smoking during the course of their disease. Among the patients who continued to smoke, 65% required an amputation , which was almost twice that seen in those who stopped smoking. In te rms of number of acute attacks, surgical procedures and smoking, no re lationship was found between early age (< 35 years) at onset and progr ession of the disease. TAO had a pronounced influence on the working l ife of many of the patients. Twelve changed their jobs because of thro mboangiitis obliterans, while 24 (34,8 %) retired prematurely on a pen sion at the mean age of 42. Conclusion: The long-term investigation sh ows that TAO is associated with frequent hospitalisations and surgical procedures. Continued consumption of tobacco in particular was found to be associated with a multiplication of the amputation rate. An infl uence of patient age at disease onset on the progression of TAO was ex cluded. In 49 (71%) of the patients, the disease resulted in terminati on of the working life by either dismissal or premature retirement.