Fate of limbs with failed vascular reconstruction in Buerger's disease patients.

We surveyed the recent condition of lower limbs with failed vascular reconstruction in patients with Buerger's disease. Forty-three patients (mean age: 41.2+/-8.7 years) received infrapopliteal vascular reconstruction at Nagoya University Hospital. Symptoms at the time of surgery were intermittent claudication in 11 patients, rest pain in 13 and ulcer/gangrene in 19. Inquiry about the condition of the lower limbs was made during March 1998. Eight patients were lost to follow-up and three patients had died. In the remaining 32 patients, mean follow-up period was 140.5+/-42.0 months. Graft was occluded within a week after surgery in six patients with ischemic ulcer/gangrene, three of whom underwent a major amputation while the trophic lesion healed in the remaining three patients. Two grafts were occluded among the 11 patients with intermittent claudication. One of these patients had mild rest pain and the other reported intermittent claudication. Two of the patients with intermittent claudication were lost to follow-up. Among the 13 patients with rest pain, one had died and six were lost-to-follow-up. Although the remaining six patients complained of intermittent claudication, half had an occluded graft. Of the 19 patients with ulcer/gangrene, two had died and all nine of those with occluded graft complained of intermittent claudication. Fate of limbs with failed vascular reconstruction was satisfactory.