THROMBOANGIITIS (BUERGER’S DISEASE) – Etiology, Clinical Manifestation, Pathophysiology, Diagnostic Evaluation and Prevention 

THROMBOANGIITIS (BUERGER’S DISEASE) – Etiology, Clinical Manifestation, Pathophysiology, Diagnostic Evaluation and Prevention

Thromboangiitis obliterans (Buerger’s disease) is a recurring progressive inflammation and thrombosis (clotting) of small and medium arteries and veins of the hands and feet

ETIOLOGY

• Current (or recent) history of tobacco use
  
• Presence of distal extremity ischemia
  
• Exclusion of other autoimmune diseases
  
• Diabetes mellitus
  
• Autoimmune reaction (one in which the body’s immune system attack the body’s own tissues)
  

 

CLINICAL MANIFESTATION

• Acute and chronic inflammation
  
• Thrombosis of arteries and veins of the hands and feet
  
• Ulcerations and gangrene in the extremities
  
• Claudication
  
• Pain at rest
  
• Ischemic ulcers or gangrene
  

 

PATHOPHYSIOLOGY

Exposure to tobacco (lead to) ---- an immunologic phenomenon (leads to) ---- vasodysfunction and inflammatory thrombi (show) ---- hypersensitivity

 

DIAGNOSTIC EVALUATION

• CT angiogram: showing segmental stenosis of arteries of the lower leg. The changes are particularly apparent in the blood vessels in the lower right hand portion
  
• Angiograms: the upper and lower extremities can be helpful in making the diagnosis of Buerger’s disease. Angiograms may also show occlusions or stenosis in multiple areas of both the arms and legs
  
• Skin biopsies: it affected extremities are rarely performed because of the frequent concern that a biopsy site near an area poorly perfused with blood will not heal well
  

 

PREVENTION

• Smoking cessation has shown to slow the progression of the disease and decrease the severity of amputation in most patients, but does not halt the progression
  
• Streptokinase has been proposed as adjuvant therapy
  
• Limaprost, oral PGE1 derivative, has shown efficacy