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Vasculitic Syndrome: Thromboangiitis Obliterans (aka Buerger’s Disease) Clinical Presentation:

  • Triad of symptoms/signs:

    • 1.

      Distal arterial occlusion

      • o

        Leads to arm and foot claudication

        • o

          Ischemia of the digits

    • 2.

      Raynaud’s phenomenon (see Diseases Causing Arterial Spasm study guide)

    • 3.

      Migrating superficial vein thrombophlebitis (inflammation of a vein caused by a blood clot)

Etiology & some Epidemiology:

  • Strongly associated with smoking.

  • Increased incidence of HLA-A9 and HLA-B5 in Thromboangiitis Obliterans patients.

  • Most common in men < 40 years old.

  • Only 2% of cases in females.

Pathology:

  • Thromboangiitis Obliterans is an inflammatory disease of small and medium size arteries, veins, and nerves.

  • It involves distal vessels of upper and lower extremities.

  • Histologic examination of affected areas of arteries shows:

    • o

      Inflammation and thrombosis without necrosis

      • o

        Preservation of internal elastic lamina

Pathophysiology:

  • Distal to the involved vessel, get ischemia that damages tissues.

Diagnostic Imaging/Testing:

  • Cannot detect and thus cannot use traditional lab markers for inflammation and autoimmune disease.

  • Arteriograph: see areas of stenosis interspersed w/ normal appearing vessels; more severe disease distally; collateral vessels with “corkscrew” appearance around stenotic regions; no atherosclerosis in proximal arteries

  • Tissue Biopsy: diagnosis can be established this way – but rarely need to do this

  • Biopsy of involved vessel: reveals an occlusive, highly cellular, inflammatory thrombus – limited vessel wall involvement, preservation of the internal elastic lamina

Treatment:

  • Only treatment is to STOP SMOKING…

    • o

      Prevents progression of disease and complications

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