Introduction[edit | edit source]
Buerger's disease or thromboangitis is an inflammatory non atherosclerotic, segmental inflammatory disease affects small and medium arteries and veins of the upper and lower limbs and more common in tobacco use patients, more common in men than women< 45 years but in last decades it is prevalence between women increase may be due to increase in number of women tobacco use. There is a strong association between heavy tobacco use and the development of Buerger's disease.
Prevalence[edit | edit source]
The prevalence of buerger's disease decreased in both the United States and in Japan, to be appears to be 12.6 / 100,000 patients in 1986 since it was 104/ 100,000 patients in 1947 according to Mayo Clinic in United States.
Mechanism of Injury / Pathological Process
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It is believed that increased tobacco use increase the level of the inflammatory process in the body, one or more component of the tobacco causes endothelial cell injury, and development of autoantibodies against the cells.
In patients with buerger’s disease we well see markedly elevation in the anti-endothelial-cell antibody (AECA) titers. At buerger's disease this inflammatory process spares all 3 wall layers of the artery and vein, with preservation the integrity of the internal elastic lamina which helping to distinguish thromboangiitis obliterans from atherosclerosis and other vasculitides.
This pathological process involves three phases: acute, subacute, and chronic.
Clinical Presentation[edit | edit source]
- Age under 45 years.
- Current or recent history of tobacco use.
- Distal ischemia as the disease begins usually in the small and distal vessels.
- Pain at rest that involves the hands or feet.
- Toes ulceration.
- Classic calf claudication like in peripheral arterial disease is uncommon.
- Foot/ arch claudication present with the anterior and posterior tibial arteries which are the most commonly affected.
- Mostly involve 3 or 4 limbs and it is rare to present with single limb affected, with upper limbs more involved, upper and lower affect about 20%–25% of the cases.
- The disease affect venous more that arterial supply.
- Exclusion of autoimmune diseases, hypercoagulability and diabetes mellitus
- Exclusion of a proximal source of emboli by echocardiography or arteriography
- Consistent arteriographic findings in the clinically involved and non-involved limbs
Diagnostic Procedures[edit | edit source]
Allen's test for suspected ulceration.
Angiogram for both upper or lower extremities in patients with suspected Buerger's disease.
Vessel biopsy, but it is rarely indicated in patient with older ages and involvement of the large arteries.
Laboratory tests, as there is not any specific laboratory test for the diagnosis of this disease but the laboratory tests are done to exclude other entities that cause occlusive vascular disease such as diabetes, for example CBC, C-RP, ESR.
Outcome Measures[edit | edit source]
Management / Interventions
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The first line and corner stone for treatment of buerger's disease is smoking cessation of cigarette or tobacco and in any form plus passive exposure must be avoided. This may help to avoid future amputation, measurements of nicotine and cotinine as a metabolite of nicotine in urine should be performed.
Protective footwear to prevent pressure ulcers, and exposure to cold should be avoided to prevent vasoconstriction.
Medical treatment[edit | edit source]
Prostaglandin analogs such as Iloprost, an effective vasodilator and important for peoples with critical limb ischemia (IV iloprost more effcetive in symptoms management).
Calcium channel blockers such as nifedipine, nicardipine or amlodipine.
For pain relief, analgesic and opiates are often used in these patients. Medications help to control symptoms.
Surgical intervention[edit | edit source]
Laparoscopic sympathectomy: for lower and upper extremities, it benefits some patients but there is not a guide for patient selection yet.
Spinal cord stimulation: for pain management.
Amputation: may be used in cases of gangrene or wide spread infection.
Physical therapy intervention[edit | edit source]
Intermittent pneumatic compression: Application of intermittent pneumatic compression to the foot and calf augments popliteal artery flow through a sharp decrease in peripheral arterial resistance.
Exercise program considered an appropriate treatment and protective method from different PAD. You will find exercises prescription for buerger's disease via this page peripheral arterial diasease.
Differential Diagnosis[edit | edit source]
- Peripheral arterial disease.
- Occlusive diseases of small and medium arteries such as (scleroderma, vasculitides)
- Diseases related to repetitive trauma such as hypothenar-hammer syndrome.
- Hypercoagulable cases.
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add appropriate resources here
References[edit | edit source]
- Klein-Weigel P, Volz TS, Zange L, Richter J. Buerger’s disease: providing integrated care. Journal of multidisciplinary healthcare. 2016;9:511.
- Piazza G, Creager MA. Thromboangiitis obliterans. Circulation. 2010 Apr 27;121(16):1858-61.
- Klein-Weigel PF, Richter JG. Thromboangiitis obliterans (Buerger’s disease). Vasa. 2014 Sep 1;43(5):337-46.
- Arkkila PE. Thromboangiitis obliterans (Buerger's disease). Orphanet journal of rare diseases. 2006 Dec;1(1):1-5.
- Cacione DG, Baptista‐Silva JC, Macedo CR. Pharmacological treatment for Buerger's disease. Cochrane Database of Systematic Reviews. 2016(2).