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Buerger’s disease
Buerger's disease is a non-atherosclerotic, inflammatory disease that causes blockages in the small and medium arteries and veins of the limbs, especially the legs. It is strongly associated with tobacco use and is characterized by recurring blood clots and inflammation within blood vessels that supply the arms and legs. The main symptoms are pain, discoloration, and ulcers in the legs that worsen with walking or standing. Treatment focuses on complete cessation of tobacco use and medications or surgery to improve blood flow.
Buerger’s disease
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- 2. “Thromboangitis Obliterans isa distinctive disease that leads to vascular insufficiency, characterised by segmental, thrombosing, acute and chronic inflammation of medium sized and small arteries and sometimes secondarily extending into the veins and nerves”. Leo Berger, 1879-1943, Professor of Urology, NYPMS, NY, USA, Described TAO in 1908
- 3. RISK FACTORS: • CIGARETTESMOKING: – Most consistent aspect of this disorder. – Hypersensitivity to intradermally injected tobacco extracts. – Increased prevalence of HLA-A9 and HLA-B5 in these patients – Common in India, Japan & Israel pointing to its genetic influences!. • SEX
- 5. MORPHOLOGY: • Sharply segmentalacute and chronic vasculitis of medium and small arteries. MICROSCOPY: • Inflammation permeates the arterial walls. • Thrombosis of the lumen. • May undergo organisation or recanalisation. • Thrombus contains microabscesses. • Characteristic migratory recurrent superficial phlebitis.
- 7. CLINICAL FEATURES • Thepatient generally complains of pain while walking at the arch of the foot. • Onset – Age: 20 -40 yrs. Spontaneous and gradual • Intermittent claudication, which progresses to ‘rest pain’. • Swelling redness and slight pain • Postural dependency Trophic changes Ulceration Gangrene. • DD: Raynaud’s disease, Senile gangrene
- 9. PHYSICAL EXAMINATION Local examination: INSPECTION: 1.Changein color. 2.Signs of ischemia 3.Buerger’s postural test. 4.Capillary filling time 5.Venous refilling
- 10. PALPATION: 1.PALPATION OF BLOODVESSELS. 2.CAPILLARY REFILLING. 3.VENOUS REFILLING. 4.ALLEN’S TEST. 5.COLD AND WARM WATER TEST. 6.NEUROLOGICAL EXAMINATION.
- 11. INVESTIGATIONS • BLOOD • URINE • STRAIGHT X-RAY • ARTERIOGRAPHY: I. RETROGRADE PERCUTANEOUS CATHETERISATION. II. DIRECT ARTERIAL PUNCTURE.
- 13. • DETERMINATION OFBLOOD VELOCITY BY ULTRASOUND DOPPLER. • ISOTOPE TECHNIQUE • BLOOD LIPIDS. • INVESTIGATION FOR VASOSPASM – Brown’s vasomotor Index. • PLETHYSMOGRAPHY.
- 15. MANAGEMENT • CESSATION OFSMOKING CAN ARREST THE DISEASE. • MEDICAL – CILOSTAZOL – PENTOXIFYLLINE • SURGICAL – TRANSLUMINAL ANGIOPLASTY & STENTING(PTE, PTFE). – BYPASS GRAFTS.