J.Jpn. Surg. Soc.. 80(1): 42-62, 1979
Original article
CHRONIC ARTERIAL INSUFFICIENCY OF THE LOWER LIMBS IN THE JAPANESE PEOPLE
II. THE EXTRISIC MECHANICAL FACTOR OF THE JUVENILE, NON-SCLEROTIC POPLITEAL OCCLUSION
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Department of Thoracic Surgery, Faculty of Medicine, University of Tokyo (Director : Prof. Masahiro Saigusa) Takaomi Tanaka |
In this report, 311 cases of the juvinile, non-sclerotic popliteal occlulions (so-called Buerger's disease in Japan) were studied from the clinical, angiographic, operative and pathological findings.
Arteriograms have confirmed our impression derived from the clinical findings that two forms of Buerger's disease exist, a proximal type, in which the popliteal artery is primary affected, and a distal type beginning in the small vessels of the foot.
Several arteriograms, obtained before there was actual thrombosis of the popliteal artery, showed the earliest stage of the lesion, namely, localized narrowing and irregularlity of the lumen of the artery in the adductor opening, the middle and terminal part of the popliteal fossa. As has been previously indicated, these particular portions have the repeated trauma by the extrinsic compression to the vascular wall in the Japanese style sitting posture "Seiza". Usually the block extends from these particular portions of the popliteal fossa upwards towards. Occasionally the clot extends from the same positions in the popliteal artery downwards and sometimes embracing the bifurcation into the anterior and posterior tibial vessels.
In each case the affected vessel was occluded by the clot which was in various stages of organization, with the corresponding intimal fibrosis. The inflammatory changes in the walls of the thrombosed vessels described by Buerger were conspicuous by their absence.
The data, above mentioned, is more suggestive of the extrinsic mechanical factor than the constitutional disease.
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