Buerger Disease

BUERGER DISEASE


BUERGER’S DISEASE (THROMBOANGITIS OBLITERANS)

  • Buerger’s disease is a non- atherosclerotic, progressive, segmental, occlusive inflammatory disorder involving small and medium sized arteries with cell mediated sensitivity to Type I and Type II collage in upper and lower extremities.
  • Inflammatory process does involve adjacent nerves and veins.
  • Triad of thromboangitis obliterans- occlusion of small and medium sized vessels, superficial thrombophelbitis, Raynaud’s phenomenon.

ETIOLOGY-

  • Mainly seen in smokers and tobacco users.
  • Common in Jewish people
  • Hormonal influence
  • Familial nature
  • Poor hygiene

PATHOLOGY-

  • Smoke → vasospasm & hyperplasia initma → thrombus & obliteration medium sized vessels → Panarteritis → Artery, vein & nerve are involved  → Blockage leads to collateral open up → Blood supply to ishchaemic areas → Compensatory peripheral vascular disease
  • Microabscesses, giant cells are found.

CLASSIFICATION-

  • Type I- upper limb TAO (rare)
  • Type II- involving legs & infrapopliteal
  • Type III- femoropopliteal
  • Type IV- aortoiliofemoral
  • Type V- generalised

CLINICAL FEATURES-

  • Common in male smokers between 20- 40 years
  • Intermittent claudication in foot & calf progressing to rest pain, ulceration & gangrene.
  • Absence of atheromas.
  • Small & medium sized vessels such as dorsalis, pedis, posterior tibial, popliteal are commonly involved.

INVESTIGATIONS-

1. Arterial Doppler & Duplex scan

2. Transformed retrograde angiogram-

  • Shows blockage
  • Cork screw appearance of the vessel
  • Inverted tree/ spider leg collaterals
  • Severe vasospasm causing rippled artery

3. Transbranchial angiogram- if femorals are not felt then transbranchial angiogram is done.

4. USG abdomen- shows abdominal aorta for block 

TREATMENT-

  • Stop smoking
  • Vasodilators- nifedipine, xanthinol nicotinate
  • Antithrombin activity- low dose of aspirin
  • Analgesics
  • Lumbar sympathectomy- for rest pain and ulcerations
  • Omentoplasty, profundoplasty
  • Amputation in gangrene

Exam Important

PATHOLOGY-

  • Smoke → vasospasm & hyperplasia initma → thrombus & obliteration medium sized vessels → Panarteritis → Artery, vein & nerve are involved  → Blockage leads to collateral open up → Blood supply to ishchaemic areas → Compensatory peripheral vascular disease
  • Microabscesses, giant cells are found.

ETIOLOGY-

  • Mainly seen in smokers and tobacco users.
  • Common in Jewish people
  • Hormonal influence
  • Familial nature
  • Poor hygiene

CLINICAL FEATURES-

  • Common in male smokers between 20- 40 years
  • Intermittent claudication in foot & calf progressing to rest pain, ulceration & gangrene.
  • Absence of atheromas.
  • Small & medium sized vessels such as dorsalis, pedis, posterior tibial, popliteal are commonly involved.
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