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    Thromboangiitis Obliterans

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    Thromboangiitis Obliterans (Buerger's Disease) is a non-atherosclerotic inflammatory disease that causes severe pain and ischemia in the hands and feet, often leading to amputation. It predominantly affects young male smokers under age 45. Pathology shows inflammatory thrombi in small and medium arteries without significant vessel wall damage. Cessation of smoking is critical to treatment, as continued smoking is associated with high amputation rates over time. Other treatments aim to improve blood flow through vasodilators or bypass surgery, but outcomes depend on smoking status.

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    Thromboangiitis Obliterans

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    mu_cr
    237 views17 pages
    Thromboangiitis Obliterans (Buerger's Disease) is a non-atherosclerotic inflammatory disease that causes severe pain and ischemia in the hands and feet, often leading to amputation. It predominantly affects young male smokers under age 45. Pathology shows inflammatory thrombi in small and medium arteries without significant vessel wall damage. Cessation of smoking is critical to treatment, as continued smoking is associated with high amputation rates over time. Other treatments aim to improve blood flow through vasodilators or bypass surgery, but outcomes depend on smoking status.

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    Buerger's disease

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    Thromboangiitis Obliterans (Buerger's Disease) is a non-atherosclerotic inflammatory disease that causes severe pain and ischemia in the hands and feet, often leading to amputation. It predominantly affects young male smokers under age 45. Pathology shows inflammatory thrombi in small and medium arteries without significant vessel wall damage. Cessation of smoking is critical to treatment, as continued smoking is associated with high amputation rates over time. Other treatments aim to improve blood flow through vasodilators or bypass surgery, but outcomes depend on smoking status.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    237 views17 pages

    Thromboangiitis Obliterans

    Uploaded by

    mu_cr
    Thromboangiitis Obliterans (Buerger's Disease) is a non-atherosclerotic inflammatory disease that causes severe pain and ischemia in the hands and feet, often leading to amputation. It predominantly affects young male smokers under age 45. Pathology shows inflammatory thrombi in small and medium arteries without significant vessel wall damage. Cessation of smoking is critical to treatment, as continued smoking is associated with high amputation rates over time. Other treatments aim to improve blood flow through vasodilators or bypass surgery, but outcomes depend on smoking status.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 17

    Thromboangiitis Obliterans

    Brenner Dixon, MD 11/15/2010 Vascular conference

    History
    Disease first described by Felix von Winiwarter in 1879 Accurate Pathologic Description in 1908 by Leo Buerger
    Pre-Senile Spontaneous Gangrene 11 amputations

    Presentation
    Claudicationhands, feet, legs, arms Raynauds phenomenon Painful open sores of fingers and toes 2/3 may have severe periodontal disease Superficial Thrombophlebitis may predate the onset of ischemic symptoms Generally Infra-popliteal or infra-brachial

    Basics
    Described as a non-atherosclerotic segmental inflammatory disease of medium and small arteries. Occurrence Rate: 12-13 per 100,000
    Worse in Indian and middle eastern ethnicities

    Progresses distil to proximal In addition to Extremities can involve cerebral, coronary, renal, mesenteric or pulmonary arteries.

    Pathophysiology
    Characterized by highly cellular inflammatory thrombus with relative sparing of the vessel wall. Patients often have increased immunity to Type1 and Type III collagen Three Phases:
    AcuteHighly cellular inflammatory thrombus
    PMNs, Giant Cell

    Chronic- organized thrombus and fibrosis Sub-acute

    Key: Preservation of internal elastic lamina

    TOA

    Atherosclerosis

    Risk Factors
    SMOKING!!! Can be through Chewing Tobacco Also reported after Marijuana Use Case reports of TOA in non-smokers

    Work-Up
    Start with history!!
    20-40s, smoker, male
    (though increasing rates of occurrence in women)

    ExamDistil ischemia
    Positive Allen test (non-specific)

    Labs: CBC, BMP, LFT, ESR, CRP, Cold Agglutinins and Cryoglobulins ABIs, PVR etc.

    Corkscrew Vessels

    Proposed Criteria (Olins)


    Age <45 Recent History of Tobacco use Distil Extremity ischemia Exclusion of Auto-immune diseases Exclusion of proximal embolic source

    Prognosis
    Amputation: (smokers)
    5 Years 25%--------11% major 10 years 38%-------21% major 20 years 46%-------23% major

    Recurrence: 5-7 Years (average) Significantly improved in non-smokers


    Minimal Amputations!!

    Treatment
    Smoking Cessation
    Nicotine replacement does not help

    Bypass
    Because of distil involvement, usually not feasible

    Vasodilators
    IloprostImproves symptoms; not outcomes

    Epidural Spinal Cord Stimulation/Denervation Streptokinase: Sparse reports; improves up to 58%

    New Treatments
    Antagonists of Cannabinoid or endothelin receptors Prostaglandin E1 Debated:
    Sympathetic Denervation: likely temporary though may help to heal lesions

    Literature Cited
    Piazza, G. Creager, MA. Thromobangiitis Obliterans. Circulation, 2010, April; 121 (16): 1858-61. Malecki, R. Zdrojowy, K. Adamiec, R. Thromboangiitis Obliterans in the 21st Centurya new face of disease. Atherosclerosis. 2009 Oct;206(2):328-34. Olin, JW. Thromboangiitis obliterans (Buergers Disease). N Engl J Med. 2000 Sep 21;343 (12):864-9.

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