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.