Updated: 10/5/2016

Thromboangiitis Obliterans (Buerger's disease)

Topic
Review Topic
0
0
Questions
1
0
0
Evidence
1
0
0
https://upload.orthobullets.com/topic/6099/images/necrotic fingers.jpg
https://upload.orthobullets.com/topic/6099/images/tao.jpg
https://upload.orthobullets.com/topic/6099/images/acute.jpg
https://upload.orthobullets.com/topic/6099/images/ulcerations.jpg
Introduction
  • A nonatherosclerotic, segmental, inflammatory disease in the small and medium-sized vessels of the hands and feet
    • occurs predominantly in smokers
  • Epidemiology
    • incidence
      • 12.6 per 100,000 in the United States
    • demographics
      • 3:1 male: female ratio
      • typically affects patients < 45 years old
    • risk factors
      • smoking
      • chewing tobacco
  • Pathophysiology
    • inflammation and clotting of the small vessels of hands and feet 
    • 3 phases
      • acute
        • thrombus including neutrophils and giant cells occludes the vessel lumen while sparing the wall
      • subacute
        • progressive organization of the thrombus
      • chronic
        • inflammation has subsided
        • organized thrombus and vascular fibrosis remain
  • Prognosis
    • depends on smoking status
      • 94% who quit smoking avoid amputation
      • 43% chance of amputation within 8 years if smoking is continued
Presentation
  • Symptoms
    • early disease
      • intermittent claudication of feet, legs, hands or arms
      • numbness and/or tingling in the limbs
    • late disease
      • symptoms of critical limb ischemia
        • rest pain
  • Physical exam
    • inspection
      • ulcerations
      • large, erythematous, superficial blood vessels
      • necrotic distal digits in hands and feet
    • palpation
      • decreased temperature in hands and feet
    • neurovascular
      • diminished or absent pulses
      • sensory findings in up to 70% of patients
    • provocative tests
      • positive Allen test in young smoker with digital ischemia is suggestive of disease
Imaging
  • Arteriography
    • indications
      • useful for ruling-out other conditions that may mimic Buerger's disease
    • findings
      • "corkscrew" vessels
      • collateral circulation giving a "spider leg" appearance
Studies
  • Labs
    • used to exclude alternative diagnoses
  • Echocardiogram
    • used to exclude proximal source of emboli
Treatment
  • Nonoperative
    • smoking cessation and symptomatic treatment
      • indications
        • all patients with Buerger's disease that use tobacco
      • techniques
        • smoking cessation
          • patient education
          • pharmacotherapy
          • smoking cessation groups
        • symptomatic treatment
          • avoid exposure to cold
          • gentle exercise
          • daily aspirin
          • vasodilators
      • outcomes
        • smoking cessation is the only treatment known to decrease the risk of future amputation
  • Operative
    • surgical sympathectomy
      • indications (controversial)
        • refractory pain and digital ischemia
      • technique
        • cut nerves to the affected areas
    • amputation
      • indications
        • gangrene
        • non-healing ulcers
        • refractory pain
 

Please rate topic.

Average 4.4 of 5 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (1)

(OBQ12.126) A 45-year-old male smoker presents with the clinical appearance shown in Figure A. Which of the following statements is true regarding his condition? Review Topic

QID: 4486
FIGURES:
1

Anticoagulation with aspirin has been shown to decrease the incidence of amputation

28%

(1426/5148)

2

Arteriography is useful in the diagnosis of his condition

44%

(2252/5148)

3

Prophylactic amputation of unaffected digits leads to improved patient outcomes

2%

(78/5148)

4

The condition is usually painless

23%

(1199/5148)

5

Involves proximal vessels first and distal vessels last

3%

(148/5148)

ML 4

Select Answer to see Preferred Response

PREFERRED RESPONSE 2
ARTICLES (2)
Topic COMMENTS (0)
Private Note