Tag: Buerger Disease

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.
Don’t Forget to Solve all the previous Year Question asked on BUERGER DISEASE

Module Below Start Quiz

Buerger Disease

Buerger Disease

Q. 1

All of the following are the clinical feature of thromboangitis obliterans except :

 A Raynaud’s phenomenon

 B

Claudication of extremeties

 C

Absence of popliteal pulse

 D

Migratory superficial thrombophlabitis

Q. 1

All of the following are the clinical feature of thromboangitis obliterans except :

 A

Raynaud’s phenomenon

 B

Claudication of extremeties

 C

Absence of popliteal pulse

 D

Migratory superficial thrombophlabitis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Absence of popliteal pulse


Q. 2

Commonest site of thromboangitis obliterans is 

 A

Femoral artery

 B

Popiteal artery

 C

iliac artery

 D

None

Q. 2

Commonest site of thromboangitis obliterans is 

 A

Femoral artery

 B

Popiteal artery

 C

iliac artery

 D

None

Ans. D

Explanation:

Ans. is ‘None’ 
Distal circulation is involved in Buerger’s disease, usually distal to popliteal and brachial artery.


Q. 3

Thromboangitis obliterans is associated with

 A

HLA B27

 B

HLA – DR4

 C

HLA – B5

 D

HLA – DR2

Q. 3

Thromboangitis obliterans is associated with

 A

HLA B27

 B

HLA – DR4

 C

HLA – B5

 D

HLA – DR2

Ans. C

Explanation:

Ans. is ‘c’ i.e., HLA – B5 

Thromboangitis obliterans (Berger disease)

  • Thrombangitis obliterans is a distinctive disease that is characterized by segmental, thrombosing acute and chronic inflammation of medium sized and small sized arteries, and sometimes secondarily extending to veins and nerves.
  • Thromboangitis obliterans occurs almost exclusively among heavy-cigarrete-smoking persons.
  • It is more common in men but incidence is increasing in women because of increasing smoking habit in women. o Buerger disease is associated with HLA B-5 and HLA-A9.
  • In thrombongitis obliterans there is acute and chronic segmental inflammation of vessels with accompanied thrombosis in the lumen.
  • Typically, the thrombus contains microabscesses with a central focus of neutrophils surrounded by gran u lomatous inflammation.
  • Later, the inflammatory process extends into contiguous veins and nerves and in time all three structures (arteries, veins and nerves) become encased in fibrous tissue, a characterstic that is very rare with other form of vasculitis.
  • Clinical manifestations
  • Thrombangitis obliterans affects vessels of upper and lower extremities.
  • Symptoms are due to vascular insufficiency, i.e. Ischemia of toes, feet and fingers that can lead to ulcer and frank gangrene.
  • Due to neural involvement, there may be severe pain, even at rest.

Q. 4 True about Buerger disease

 A

Affects larger artery only

 B

Younger males are more commonly affected

 C

Phlebitis migrans is characteristic

 D

Cold intolerance

Q. 4

True about Buerger disease

 A

Affects larger artery only

 B

Younger males are more commonly affected

 C

Phlebitis migrans is characteristic

 D

Cold intolerance

Ans. B:C:E

Explanation:

Answer- B,Younger males are more commonly affected C,Phlebitis migrans is characteristic E,Veins may involved
Also called as Thromboangiitis Obliterans
It is a inflammatory occlusive vascular disorder involving small and medium sized arteries and veins in upper and lower extremities.
It involves tibial and radial arteries and sometimes secondarily extending to veins and nerves of extremities.
The clinical features of thromboangiitis obliterans includes a triad of claudication of the affected extremity, Raynaud’s phenomenon, and migratory superficial vein thrombophlebitis.

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