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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