Angiographic findings in Buerger disease

To clarify the angiographic findings in patients with Buerger disease and to elucidate the relationship between the angiographic findings and the clinical prognosis, 144 angiographic images of the lower extremities of 119 patients with Buerger disease have been studied. The present study has included patient data in our previous report. Results of this study revealed that in lower extremities showing a femoropopliteal arterial occlusion (n = 57), the frequency of gangrene was significantly lower statistically in limbs in which the main arteries of the lower leg and foot were well visualized (2 (12%) of 17 limbs) than in limbs in which the main arteries did not visualize (25 (63%) of 40 limbs) (P < 0.001). Further, in lower extremities showing a crural arterial occlusion (n = 59), the incidence of pedal gangrene increased as the extent of pedal arterial occlusion increased, though this rise was not statistically significant. Also, the collateral vessels had a ‘corkscrew’ appearance in 39 (27%) of 144 limbs affected by Buerger disease, whereas this appearance was seen in only 2 (3%) of 63 limbs of patients with arteriosclerosis obliterans (P < 0.001). Another finding of this study is that corkscrew-shaped vessels that extend from the sites of the arterial occlusion to the periphery of the feet without opacification of the main pedal arteries indicate a poor prognosis. Based on the above findings, we thus believe that the appearance of corkscrew-shaped vessels is the most characteristic feature of Buerger disease and that each represents a dilated vasa vasorum of the occluded main arteries.