Long‐Term Outcome and Prognostic Factors of Complications in Thromboangiitis Obliterans (Buerger's Disease): A Multicenter Study of 224 Patients

BACKGROUND: Data regarding long‐term outcome of patients with thromboangiitis obliterans are lacking and most series come from India and Japan. In this study, we assess long‐term outcome and prognostic factors in a large cohort of thromboangiitis obliterans. METHODS AND RESULTS: Retrospective multicenter study of characteristics and outcomes of 224 thromboangiitis obliterans patients fulfilling Papa's criteria were analyzed. Factors associated with vascular events and amputations were identified. The median age at diagnosis was 38.5 (32–46) years, 51 (23.8%) patients were female, and 81.7% were whites. After a mean follow‐up of 5.7 years, vascular events were observed in 58.9%, amputations in 21.4%, and death in 1.4%. The 5‐, 10‐, and 15‐year vascular event‐free survival and amputation‐free survival were 41% and 85%, 23% and 74%, and 19% and 66%, respectively. Ethnic group (nonwhite) (hazard ratio 2.35 [1.30–4.27] P=0.005) and limb infection at diagnosis (hazard ratio 3.29 [1.02–10.6] P=0.045) were independent factors of vascular event‐free survival. Factor associated with amputation was limb infection (hazard ratio 12.1 [3.5–42.1], P<0.001). Patients who stopped their tobacco consumption had lower risk of amputation (P=0.001) than those who continued. CONCLUSIONS: This nationwide study shows that 34% of thromboangiitis obliterans patients will experience an amputation within 15 years from diagnosis. We identified high‐risk patients for vascular complications and amputations.