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BUERGER’S DISEASE

Satria Pandu Persada Isma

Background
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Also known as thromboangiitis obliterans Nonatherosclerotic, segmental, inflammatory, vasoocclusive disease Affects the small- and medium-sized arteries and veins of the upper and lower extremities Strongly associated with heavy tobacco use.

HLA-A54.Patophysiology   Etiology is unknown Exposure to tobacco is essential for both initiation and progression of the disease Immunologic phenomenon that leads to vasodysfunction and inflammatory thrombi Prevalence of HLA-A9. and HLA-B5 is observed.   .

6-20 cases per 100.000 population (US) More common in males (M:F ratio 3:1)   Most patients are aged 20-45 .Frequency  12.

hypercoagulable states.History  Age younger than 45 years    Current (or recent) history of tobacco use Presence of distal extremity ischemia Exclusion of autoimmune diseases. and diabetes mellitus Exclusion of a proximal source of emboli   Consistent arteriographic findings .

or fingers Involvement of large arteries is unusual May also present with claudication of the feet.)  70-80%present with distal ischemic rest pain and/or ischemic ulcerations on the toes. feet. hands. or arms and often describe the Raynaud phenomenon May present with foot infections    . legs.History (contd.

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Physical Exam       Develop painful ulcerations and/or frank gangrene of the digits Hands and feet are usually cool and mildly edematous Superficial thrombophlebitis (often migratory) Paresthesias Impaired distal pulses 80% percent of patients present with involvement of 3-4 limbs. .

)  Determine the colour  Temperature  Vascular angle  Cappilary refilling  Capillary filling time  Feel all the pulses  Venous filling  Auscultate  Pressure areas  Check all the nerves  Allen’s test .Physical Exam (contd.

other causes    Atherosclerosis .Differentials   Raynaud phenomenon Systemic lupus erythematosus Antiphospholipidantibody syndrome Diabetes mellitus      Carpal tunnel syndrome Peripheral neuropathy Neurotrophic ulcers Trauma Vasculitis.

Laboratory Workup  No specific laboratory tests confirm or exclude the diagnosis of Buerger disease Primary goal of a laboratory workup in patients thought to have the disease is to exclude other disease processes  .

Imaging Studies  Angiography/arteriography – nonatherosclerotic. segmental occlusive lesions of the small.and medium-sized vessels – corkscrew collaterals  Echocardiography .

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Morphology Segmental acute & chronic vasculitis with secondary spread to contiguous veins and nerves  Inflammation permeates arterial walls accompanied by thrombosis of the lumen  Characteristically the thrombus contains microabscesses marked by a central focus of neutrophils surrounded by granulomatous inflammation  .

Medical Care Absolute discontinuation of tobacco use is the only strategy proven  Use of thrombolytic therapy remains inconclusive  Intravenous iloprost ?  Use of well-fitting protective footwear  Avoidance of cold environments  Avoidance of drugs that lead to vasoconstriction  .

Surgical Treatment  Surgical revascularization for Buerger disease is usually not feasible Autologous vein bypass Sympathectomy Amputation    .

activity should be restricted by symptoms only  .Diet & Activity  No dietary restrictions are needed Encourage cardiovascular exercise.

splenic. renal.Complications     Ulcerations Gangrene Need for amputation Rare occlusion of cerebral. coronary. or mesenteric arteries .

Prognosis  Among patients with who quit smoking. 94% avoid amputation Patients who continue smoking there is a 43% chance that an amputation will be required sometime during a 7-8 year period Mortality is rare   .

GRAZIE .