Outcomes of endovascular revascularization of upper limb thromboangiitis obliterans via palmar arch angioplasty.

BACKGROUND

Thromboangiitis obliterans (TAO), or Buerger's disease, is a rare, nonatherosclerotic segmental vasculitis affecting small- and medium-sized arteries, most commonly in the extremities. Upper extremity involvement presents unique therapeutic challenges, particularly in preserving hand function and preventing amputation.

METHODS

We retrospectively reviewed nine male patients with angiographically confirmed upper extremity TAO. Demographics, angiographic findings, procedural details, and clinical outcomes - including revascularization success and amputation rates - were analyzed. Palmar arch angioplasty was attempted in patients with suitable anatomy and critical ischemia.

RESULTS

The mean age was 50.3±4.4 years. All patients were active smokers (mean 28.2±4.1 pack-years). Six patients (66.7%) presented with digital gangrene, while three (33.3%) had ischemic ulceration. Radial artery involvement was present in all patients, and ulnar artery involvement in 77.8%. Palmar arch angioplasty was attempted in six patients and technically successful in four (66.7%). Minor amputations occurred in eight patients (88.9%), while no major amputations were required. Patients with successful revascularization experienced improved wound healing and limb salvage.

CONCLUSIONS

Endovascular revascularization, including palmar arch angioplasty, may represent a feasible limb-salvage approach in selected patients with upper extremity TAO; however, clinical outcomes remain variable, minor amputations are still frequently observed, and the technique should be interpreted as a supportive measure rather than a definitive solution.