Buerger Disease

• • 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

Epidemiology

• • Young cigarette-smoking men

Symptoms and Signs

• • 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

Imaging Findings

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

• • Precise diagnosis only made by microscopic evaluation

• • 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

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

  • Sympathectomy decreases arterial spasm in some patients

  • Amputation for pain/gangrene

Surgery

Indications

• • Severe symptoms

  • Necrosis/gangrene

References