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  • • Also known as thromboangiitis obliterans

    • -Characterized as multiple segmental small arteries occlusions in distal extremities

    • Involves all 3 layers of arterial wall with infiltration of round cells

    • Healing of lesion results in fibrous obliteration of lumen in segmental fashion

    • Upper and lower extremities affected

    • Many patients have specific cellular immunity against arterial antigens and elevated immune complexes

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Epidemiology

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  • • Young cigarette-smoking men

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Symptoms and Signs

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  • • Migratory phlebitis

    • Symptoms range from digital pain to coolness and cyanosis, to necrosis and gangrene

    • Foot claudication may be first symptom

    • On exam, patients often have irregular pattern of ischemia

    • Allen test demonstrates delayed filling of affected digital arteries

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Imaging Findings

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  • • Angiography findings distinctive but not pathognomonic; tapering of proximal vessel, artery is smooth, not irregular, multiple wispy collateral present

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  • • Precise diagnosis only made by microscopic evaluation

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  • • HLA typing may distinguish patients with Buerger disease from those with atherosclerosis

    • Microscopic diagnosis necessary

    • -Shows lymphocytic infiltration into all layers of vessel wall

    • Arteriographic findings distinctive but not pathognomonic

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  • • Cessation of smoking essential to avoid disease progression and may even become dormant

    • Sympathectomy decreases arterial spasm in some patients

    • Amputation for pain/gangrene

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Surgery

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Indications

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  • • Severe symptoms

    • Necrosis/gangrene

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References

Paraskevas KI. et al. Thromboangiitis obliterans (Buerger's disease): searching for a therapeutic strategy. Angiology 2007 58(1):75-84.  [PubMed: 17351161]

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