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&ERGER'S DSEASE
" Thromboangiitis Obliterans (TAO)
Definition:
TAO is a nonatherosclerotic vascular disease
characterized by the absence or minimal
presence of atheromas, segmental vascular
inflammation, vasoocclusive phenomenon, and
involvement of small- and medium-sized
arteries and veins of the upper and lower
extremities.
Anatomy and Physiology
The vascular system consists of two
interdependent systems. The right side of the
heart pumps blood through the lungs to the
pulmonary circulation, and the left side of the
heart pumps blood to all other body tissues
through the systemic circulation. The blood
vessels in both systems channel the blood from
the heart to the tissues and back to the heart.
The amount of blood flow needed by the body
tissues constantly changes. The percentage of
blood flow received by individual organs or
tissues is determined by the rate of tissue
metabolism, availability of oxygen and function
of tissues. When metabolic requirements
increase, blood vessels dilate to increase the
flow of oxygen to tissues. When metabolic
needs decrease, vessels constrict and blood
flow to the tissue decreases. f the blood
vessels fail to dilate in response to the need for
increased blood flow, tissue ischemia results.
Pathophysiology:
nflammatory cells adhere to the intima of the
artery. This leads to thrombus formation and
vasospasm that decreases the blood supply to
the small arteries and the mid-size arteries. This
causes scarring and fibrosis of affected toes
that leads to gangrene.
Clinical Manifestations
Acute, severe, burning or tingling pain
in the hands and feet
Digital rest pain
Superficial thrombophlebitis

ntermittent claudication/ foot cramps
Skin ulcers
ntense rubor of the foot
Absence of bipedal pulse/ radial and
ulnar pulse maybe diminished or
absent if the upper extremities are
involved
Etiology
Autoimmune vasculitis
Genetics
Men of age 20-35 years
Smoking and chewing tobacco
Diagnosis
-Recommended tests to rule out other cause of
vasculitis includes: CC, liver function test,
&N-Creatinine Determination test, FS,
serological markers for CREST syndrome or
scleroderma, hypercoagulopathy screening.
-Contrast angiography is used to identify the
diseased portion
- Segmental limb blood pressures are taken to
demonstrate the distal location of the lesions or
occlusions
-Duplex ultrasonography is used to determine
the patency of the proximal vessels and visual
the extent of the distal disease


Medical Management

Efforts are directed to improve circulation to the
extremities, prevent the progression of the
disease and prevent the extremities from
trauma and infection. smoking cessation is
advised, analgesics and oral antibiotics are
prescribed and topic antibiotics are applied to
affected areas.

Surgical Management

Debridement
Ganglionectomy for vasodilation and
to increase blood flow
Amputation: for gangreneous areas
(moist, severe rest pain, severe
sepsis)



Nursing Management

Assist in planning for cessation in
smoking and management of pain
Encourage patient to make lifestyle
changesdiet, exercise, hygiene
Care to extremities are highlighted-
avoidance of wearing poorly fitting
footwear, fungal infection
Advise to avoid conditions that may
exacerbate symptoms: exposure to
cold, emotional stress etc.

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