[Thromboangiitis obliterans (Buerger's disease). Study of 41 cases]

Abstract

Background: The aim of this study was to know the prevalence, clinical and immunological characteristics and evolution of thromboangiitis obliterans.

Methods: Between 1982-1990 41 cases of thromboangiitis obliterans were diagnosed from among 373,899 patients registered (11/100,000) according to the clinical and arteriographic criteria. Of these 41 cases 40 were males with mean age 36 +/- 7 years (mean +/- SD) with only two cases being over 45 years of age. In 40 cases was followed for 44 +/- 29 months (mean +/- SD).

Results: All the patients had ischemia of the lower limbs, 34% of the upper limbs, 39% superficial thrombophlebitis, 53% Raynaud's phenomenon, 5% mesenteric ischemia, and 7% myocardial infarction. In 30 symptomatic patients anticardiolipin antibodies were determined and one patient was positive for IgG antibodies. In the 23 patients in whom HLA and anticollagen antibody studies were performed a significant increase was found in HLA-B35, HLA-B40 and type VI denaturalized anticollagen antibodies compared to controls. In general the evolution was progressive when the patients continued smoking and favorable when tobacco was given up except in 2 cases who stopped smoking and in whom the disease progressed and death occurred. The total number of patients who died during follow up was 3 (7%), 2 due to mesenteric ischemia and the third during i.v. infusion of PGE1.

Conclusions: The results demonstrate that thromboangiitis obliterans is a rare disease in Spain. The involvement of visceral arteries is not very infrequent with worse prognosis when the mesenteric arteries are involved. There is a significant increase of determined HLA antigens and anticollagen antibodies in the patients with thromboangiitis obliterans.