Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 8 2021

Buerger Disease (Thromboangiitis Obliterans)

  • Snapshot
    • A 30-year-old man presents to his physician’s office for intermittent pain in his hands and feet and discoloration of 3 of his fingers, which he says is painful. He has had pain in his extremities for about 1 year now, but this is the first time he’s seen discoloration of his fingers. He has a 20-pack-year smoking history.
  • Introduction
    • Clinical definition
      • an inflammatory vasculitis characterized by claudication from vaso-occlusion
        • also known as thromboangiitis obliterans
    • Associated conditions
      • Raynaud phenomenon
  • Epidemiology
    • Demographics
      • male > female
        • 3:1 ratio
      • common in adults < 40 years of age
    • Risk factors
      • smoking is the strongest risk factor
    • Pathogenesis
      • primarily a medium vessel vasculitis, but the disease can also affect the small vessels
      • the disease is thought to be due to a combination of immunologic hypersensitivity to tobacco extracts, defects in endothelium-dependent vasodilation, and anti-endothelial cell antibodies
  • Presentation
    • Symptoms
      • intermittent claudication and pain in the feet or hands
      • numbness or tingling
      • may have autoamputation of digits
      • Raynaud phenomenon
    • Physical exam
      • superficial thrombophlebitis
        • often migratory
        • distended veins with redness and tenderness
        • darkened or discolored skin
      • gangrene
      • cool extremities
      • limb ischemia
        • pain, paresthesia, pallor, mottling, pulselessness, and poikilothermia
      • ischemic ulcers, especially in the toes or fingers
  • Imaging
    • Echocardiography
      • indication
        • for all patients to exclude another source of distal vessel occlusion
  • Studies
    • Laboratory evaluation should be used to exclude other autoimmune diseases
    • Arteriography
      • indication
        • diagnostic
      • findings
        • non-atherosclerotic segmental occlusion of primarily medium-sized vessels, but also small-sized vessels
        • corkscrew collaterals found around the area of occlusion
    • Biopsy of involved vessels
      • indication
        • performed only if the diagnosis is uncertain
    • Histology
      • segmental thrombosing vasculitis
  • Differential
    • Raynaud phenomenon
      • distinguishing factor
        • typically does not result in ulcers, gangrene, or need for amputation
    • Polyarteritis nodosa
      • distinguishing factor
        • often is accompanied by systemic symptoms such as fever or weight loss and is not associated with smoking
    • Making the diagnosis
      • based on a history of current or recent tobacco use and clinical presentation
  • Treatment
    • Management approach
      • Buerger disease and its progression are strongly associated with smoking use
        • therefore, management is aimed at smoking cessation, and pharmacologic therapy is ineffective
    • Conservative
      • smoking cessation
        • indication
          • for all patients
      • activities to increase circulation
        • indication
          • for all patients
        • modalities
          • apply warmth
          • exercise
    • Operative
      • amputation
        • indications
          • nonhealing ulcers
          • gangrene
          • pain refractory to all other measures
  • Complications
    • Sepsis
    • Need for amputation
  • Prognosis
    • Typically resolves with cessation of smoking
    • Patients who do not stop smoking often eventually undergo amputation
1 of 0
1 of 1
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options