Long-term outcomes and prognostic factors of major amputation in thromboangiitis obliterans after drug therapy and endovascular procedures: A real-world cohort study.

Objectives: Data regarding the long-term outcomes of patients with thromboangiitis obliterans (TAO) after drug therapy (DT) alone and endovascular procedure (EP)+ drug therapy (DT) are limited. In this study, we compared the long-term outcomes and prognostic factors of major amputation in TAO patients treated with DT alone and those treated with EP+ DT.

Methods: Consecutive patients with TAO treated at Ganzhou People's Hospital between 2012 and 2022 were included in this real-world study. All patients were administered DT. Some patients were treated with EP in addition to DT. The patients were classified into two groups: the DT group and the EP+ DT group. Long-term follow-up was sustained for all patients after treatment, and limb events were documented throughout the follow-up period. Cox regression analyses were used to analyze the factors associated with major amputation of the TAO.

Results: A total of 150 TAO patients with 175 lower limb lesions were included in the study and the number of patients in DT group and EP+ DT group was 81 and 69, respectively. The technical success rate in the EP group was 82.6%. The major amputation was performed in 19 and 21 patients in the respective groups, accounting for 26.7% of the total patients. The Kaplan-Meier curves for major amputation did not significantly differ between the two groups. Cox regression analysis revealed that disease duration (hazard ratio (HR), 0.865; 95% confidence interval (CI) [0.783-0.979], p = 0.005), wound grade (HR, 2.240; 95% CI 1.565-3.207], p < 0.001) and current smoking (HR, 3.075; 95% CI 1.317-7.812], p = 0.009) were independent factors for major amputation in patients with TAO.

Conclusion: In terms of long-term outcomes, major amputation in TAO patients did not seem to be related to the treatment methods despite a higher immediate patency rate observed after endovascular procedures. Additionally, we identified independent factors for major amputation.