Pattern of vascular involvement in patients with critical limb ischemia secondary to TAO

Introduction: Thromboangiitis obliterans (TAO) is smoking realted vasculopathy. Though traditionally described to be only a medium and small vessel disease, we do see patients with a more proximal pattern of disease in clinical practice. We undertook this study to relook at the site of vascular involvement in patients with critical ischemia secondary to TAO in our population. Materials and methods: We performed a retrospective analysis of inpatient records of all patients over a 6 year period from 2005-2010 for the clinical presentation, interventions performed and outcome in patients diagnosed to have critical ischemia secondary to TAO. Results: There were 1273 admissions for peripheral vascular disease of which TAO formed 11.9%. There was only one female patient in this series. The mean age of our patients at presentation was 37.8 years and the mean age since the start of the disease was 36.0 years (16-50). The mean smoking pack year was 15.39. Based on clinical examination and imaging, 5 (3.29%) patients had aorto-iliac disease, 6 (3.95%) patients had iliofemoral disease, 63 (41.4%) had femoropopliteal disease and 78 (51.3%) had only tibial involvement. Eighty four (55.26%) patients presented with bilateral lower limb involvement. Twenty (28.4%) patients had upper limb involvement. Only 5 (3.29%) patients had recorded superficial thrombophlebitis. Conclusions: The clinical presentation of thromboangitis is not limited to distal disease in Indians. Patients with involvement of the the more proximal segments may respond to revascularisation procedures. Introduction It was Leo Buerger’s description of TAO, published in 1908, that lent his name to the condition. Since then, there have been changes in the epidemiology of the disease. From being understood as a peculiar affliction of Jews, it became a disease of the lower socio-economic societies. It was earlier reported as forming the larger part of peripheral vascular disease in India. Dr. Vira Reddy described a variant South Indian arteritis and outcomes of angiosome based revascularisation isreported. However, literature regarding the pattern of vessel involvement in Buerger’s disease in Indian patients is lacking. Methods We collected data retrospectively, from in-patient records, and identified all in-patient admissions for peripheral vascular disease. We further shortlisted patients with Buerger’s disease. Shionoyas criteria was used to diagnose TAO. These were an age of onset less than 50, a history of significant tobacco use, absence of other risk factors for atherosclerosis, medium vessel involvement (infra-popliteal/brachial disease), upperlimb involvement or superficial thrombophlebitis. Patients with positive lab tests for vascuiltis, cardiac emboli or hyperhomocystenemia were excluded. The site of involvement was noted along with the intervention offerred . Results In our series, out of a total of 1273 patients admitted with various peripheral vascular diseases, we had 152 patients of Buerger’s disease admitted over a 6 year period from Jan 2005 to Dec 2010. These constitute a section of patients who have intractable pain requiring interventions. We had a male preponderance (151/152) reflecting the prevalent smoking habits in our population. The mean age of our patients at presentation was 37.8 years and the mean age since the start of the disease was 36.0 years (16-50). Data on smoking was obtained from 53 patients and the mean smoking pack year was 15.39. We looked at the pattern of vascular involvement and found that 5 (3.29%) patients had aorto-iliac disease, 6 (3.95%) patients had iliofemoral disease, 63 (41.4%) had femoro-popliteal disease and 78 (51.3%) had only tibial involvement. Eighty four (55.26%) patients presented with bilateral lower limb involvement. Twenty (28.4%) patients had upper limb involvement. Only 5 (3.29%) patients had recorded superficial thrombophlebitis. The mean age at presentation of patients with aorto-iliac disease was 38.4 years and the mean age at onset was 37.6 years with a 17.5 pack year history of smoking. The only female patient in our study fell in this group of vascular involvement. More patients (4/5) in this group had surgical interventions. Three had arterial bypass surgeries with one of them having an amputation 4 months later. One had CT guided sympathectomy for pain relief. Six patients had iliofemoral segment diseae. The mean