# Relationship between COVID-19 Infection and Buerger's Disease-Related Amputations

## Authors

- Mehmet Yilmaz ([ORCID](https://orcid.org/0000-0002-1366-9163)) — Department of orthopedics and traumatology, 25 Aralık State Hospital, Gaziantep, Turkey
- Nevzat Gonder ([ORCID](https://orcid.org/0000-0003-0691-1289)) — Department of Orthopedics and Traumatology, Faculty of Medicine, Gaziantep Islamic Science and Technology University, Gaziantep, Turkey

## Article information

- **Journal:** The Ulutas Medical Journal (Ulutas Med J), ISSN 2149-388X
- **Issue:** Volume 9, Issue 3 (2023), pages 193–201
- **Article type:** Original Article
- **Published online:** 2023-09-13
- **DOI:** [10.5455/umj.20230903113816](https://doi.org/10.5455/umj.20230903113816)
- **Licence:** [CC BY-NC 4.0](https://creativecommons.org/licenses/by-nc/4.0/)
- **Article page:** https://www.ulutasmedicaljournal.com/?mno=168118
- **PDF:** https://www.ulutasmedicaljournal.com/pdf/168118.pdf

## Abstract

Introduction: Thromboangiitis obliterans (TAO) or Buerger's disease is a non-atherosclerotic, inflammatory arteritis involving small and medium-sized arteries and veins of the extremities, often causing gangrene and scarring. Coronavirus disease (COVID-19) may predispose to both arterial and venous thromboembolic complications. This study examined the relationship between COVID-19 infection and Buerger's disease-related amputations. Materials and Methods: Between January 2018 and July 2023, 54 patients who applied to our clinic for Buerger's disease and were followed up and treated were analyzed retrospectively. Follow-up information, demographic data of patients (age, gender, body mass index (BMI), education status), when they were diagnosed, amount of smoking (pack/year), all treatments applied for Buerger's disease (Pre-Covid – Covid period – Covid Afterwards), presence or absence of limb amputation, continued smoking, medications, cardiovascular risk factors, Charlson Comorbidity Index (CCI), Venous Thromboembolic Event (Pulmonary Embolism), Covid-19 History and vaccination information were noted. Results: The mean age of 54 patients included in the study was 38.1 (27-49), all male. The mean smoking rate was 32 (16 - 60) packs/year, and the mean exposure to the SARS-CoV-2 virus was 1.22 (0-4) times. There was a significant correlation between major amputations due to Buerger's disease and age, severity of COVID-19 disease, and systemic hypertension (p

## Keywords

Buerger Disease; COVID-19 Disease; Amputation; Hypertension

## How to cite

Yilmaz M, Gonder N. Relationship between COVID-19 Infection and Buerger's Disease-Related Amputations. Ulutas Med J. 2023;9(3):193-201. doi:10.5455/umj.20230903113816

## References

1. Buerger L. Thrombo-Angiitis Obliterans: A Study Of The Vascular Lesıons Leadıng To Presenile Spontaneous Gangrene. The American Journal of the Medical Sciences (1827-1924). 1908;136(4):567. https://doi.org/10.1097/00000441-190810000-00011
2. Le Joncour A, Soudet S, Dupont A, et al. Long‐term outcome and prognostic factors of complications in thromboangiitis obliterans (Buerger's disease): a multicenter study of 224 201 77 COVID-19 and Buerger-Related Amputations Yılmaz & Gonder patients. Journal of the American Heart Association. 2018;7(23): e010677. https://doi.org/10.1161/jaha.118.010677
3. Watanabe Y, Shimizu Y, Hashimoto T, et al. Demographic Traits, Clinical Status, and Comorbidities of Patients With Thromboangiitis Obliterans in Japan. Circ J. 2023. https://doi.org/10.1253/circj.cj-23-0211
4. Modaghegh MHS, Kamyar MM, Shafiei A, Shariatmaghani SS, Saremi E, Sadeghipour Kermani F. A comprehensive review of the epidemiology and clinical features of 91 cases with Buerger's disease. Vascular. 2023:17085381231175257. https://doi.org/10.1177/17085381231175257
5. Bilge A, Karasoy I, Neziroğlu E, Güner Y. Upper extremity arterial thromboembolism in a patient with severe COVID-19 pneumonia: A case report. Joint diseases and related surgery. 2021;32(2):551. https://doi.org/10.52312/jdrs.2021.82766
6. Etkin Y, Conway AM, Silpe J, et al. Acute arterial thromboembolism in patients with COVID-19 in the New York City area. Annals of vascular surgery. 2021;70:290-4. https://doi.org/10.1016/j.avsg.2020.08.085
7. Klok F, Kruip M, Van der Meer N, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID- 19. Thrombosis research. 2020;191:145-7. https://doi.org/10.1016/j.thromres.2020.04.013
8. Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis research. 2020;191:9-14. https://doi.org/10.1016/j.thromres.2020.04.024
9. Shionoya S. What is Buerger's disease? World Journal of Surgery. 1983;7:544-51. https://doi.org/10.1007/bf01655948
10. Houghton DE, Wysokinski W, Casanegra AI, et al. Risk of venous thromboembolism after COVID‐ 19 vaccination. Journal of Thrombosis and Haemostasis. 2022;20(7):1638-44. https://doi.org/10.1111/jth.15725
11. Al-Ani F, Chehade S, Lazo-Langner A. Thrombosis risk associated with COVID-19 infection. A scoping review. Thrombosis research. 2020;192:152-60. https://doi.org/10.1016/j.thromres.2020.05.039
12. COVIDSurg C, GlobalSurg C. SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study. Anaesthesia. 2022;77(1):28-39. https://doi.org/10.1111/anae.15563
13. İğrek S, Ulusoy İ, Çeliksöz AH. Does COVID-19 vaccine exacerbate rotator cuff symptoms? A prospective study. BMC Musculoskeletal Disorders. 2023;24(1):551. https://doi.org/10.1186/s12891-023-06660-y
14. Kivrak A, Ulusoy I. Surgical results of different interventions in open surgery for wrist dorsal ganglion cyst. 2023. https://doi.org/10.5455/annalsmedres.2023.05.111
15. Nopp S, Moik F, Jilma B, Pabinger I, Ay C. Risk of venous thromboembolism in patients with COVID‐ 19: a systematic review and meta‐ analysis. Research and practice in thrombosis and haemostasis. 2020;4(7):e12439. https://doi.org/10.1002/rth2.12439
16. Fazeli B, Ravari H, Assadi R. Natural history definition and a suggested clinical approach to Buerger's disease: case-control study with survival analysis. Vascular. 2012;20(4):198-202. https://doi.org/10.1258/vasc.2011.oa0323
17. Ohta T, Ishioashi H, Hosaka M, Sugimoto I. Clinical and social consequences of Buerger disease. Journal of vascular surgery. 2004;39(1):176-80. https://doi.org/10.1016/j.jvs.2003.08.006
18. Dokuyucu R, Gokce H, Sahan M, et al. Systemic side effects of locally used oxymetazoline. Int J Clin Exp Med. 2015;8(2): 2674-8.
19. Koca I, Ucar M, Arik HO, Yilmaz M, Dokuyucu R. Alpha-lipoic acid could be a promising treatment in steroid-induced osteonecrosis. Eur Rev Med Pharmacol Sci. 2022;26(20):7404-12.
20. Dokuyucu R, Cevik C, Ozler GS, et al. Determination of oxidative stress and effect of erdosteine on rhinitis medi camentosa in a rat model. Eur J Pharmacol. 2014;742:153-7 https://doi.org/10.1016/j.ejphar.2014.09.009
21. Ejagwulu FS, Amaefule KE, Lawal YZ, Maitama IM, Audu SS, Delia T. Peripheral Gangrene and Extremity Amputations - Painful Preventable Sequelae of Meningococcal Septicaemia: Case Series Reports. West Afr J Med. 2020;37(2):189-96.
22. Burleva EP, Korelin SV. [Prospects of clinical application of cilostazol for peripheral artery disease]. Angiol Sosud Khir. 2020;26(3):28-36. https://doi.org/10.33529/angiq2020304
23. Sabaz MS, Aşar S. Yoğun Bakım Ünitesinde Takip Edilen Koronavirüs Hastalığı-2019 Hastalarında Charlson Komorbidite İndeksi ve Pnömoni Şiddet İndeksinin Mortalite ile İlişkisi. Turkish Journal of Intensive Care. 2021;19(1). https://doi.org/10.4274/tybd.galenos.2021.87587
24. Tikici D, Sadettin E, Tez M. Acil kolorektal cerrahi yapılan hastalarda mortaliteyi öngörmede Amerikan Anesteziyoloji Derneği Sınıflaması (ASA) ve Charlson Komorbidite İndeksi (CCI)’nin karşılaştırılması. Turkish Journal of Clinics and Laboratory. 2018;9(3):162-5. https://doi.org/10.18663/tjcl.450882
25. Gibson TB, Driver VR, Wrobel JS, et al. Podiatrist care and outcomes for patients with diabetes and foot ulcer. Int Wound J. 2014;11(6):641-8. https://doi.org/10.1111/iwj.12021