What is the role of surgery in the treatment of thromboangiitis obliterans (TAO) (Buerger disease)?

Updated: Jul 27, 2020
  • Author: Naiem Nassiri, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Because of the diffuse segmental nature of TAO and the disease’s predilection for small and medium-sized arteries, surgical revascularization for TAO usually is not feasible. Nevertheless, every effort should be made to improve distal arterial flow in patients with TAO, and autologous vein bypass of coexistent large-vessel atherosclerotic stenoses should be considered in patients with severe ischemia who have an acceptable distal target vessel.

Other proposed surgical treatments for TAO are as follows:

  • Sympathectomy
  • Intra-arterial infusion of reserpine
  • Spinal cord stimulator implantation

The ultimate surgical therapy for refractory TAO (in patients who continue smoking) is distal limb amputation for nonhealing ulcers, gangrene, or intractable pain. Amputation should be avoided whenever possible, but if it is necessary, it should be performed in a way that preserves as much of the limb as possible.


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