Buerger's Disease

NewsBot · Jun 4, 2012

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Endovascular Treatment Is a Hope for Patient With Buerger’s Disease and Foot Ulcer: Case Report
Javier Aragón-Sánchez, et al
International Journal of Lower Extremity Wounds June 3, 2012

Scarce information exists regarding the usefulness of the endovascular approach in patients with thromboangiitis obliterans and critical ischemia. A 41-old-man diagnosed with Buerger’s disease had rest pain and a severe ulceration on the big toe. He had been scheduled for a big toe amputation. Typical findings of Buerger’s disease were found in the angiogram including below-the-knee involvement and corkscrew collateral arteries. Stenoses of the posterior tibial artery were angioplastied and the plantar artery was recanalized and angioplastied. Healing was achieved and the patient remains asymptomatic 21 months after the procedure. The outcome achieved in this case and recent series should encourage doctors dealing with this problem to attempt limb salvage by means of the endovascular approach.
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NewsBot · Jun 4, 2012

Thromboangiitis obliterans

"Buerger disease" redirects here. Not to be confused with Berger's disease.

Medical condition

Thromboangiitis obliterans, also known as Buerger disease (English /ˈbɜːrɡər/; German: [ˈbʏʁɡɐ]) or Winiwarter-Buerger disease, is a recurring progressive inflammation and thrombosis (clotting) of small and medium arteries and veins of the hands and feet. It is strongly associated with use of tobacco products,^[2] primarily from smoking, but is also associated with smokeless tobacco.^[3]^[4]

^ Ferri FF (2003). Ferri's Clinical Advisor 2004: Instant Diagnosis and Treatment (6th ed.). p. 840. ISBN 978-0323026680.

^ Joyce JW (May 1990). "Buerger's disease (thromboangiitis obliterans)". Rheumatic Disease Clinics of North America. 16 (2): 463–70. doi:10.1016/S0889-857X(21)01071-1. PMID 2189162.

^ Mayo Clinic Staff. "Overview of Buerger's disease". Mayo Clinic. Retrieved 13 February 2016.

^ "Thromboangiitis obliterans". Medline Plus. U.S. National Library of Medicine. Retrieved 13 February 2016.

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NewsBot · Apr 11, 2015

Mechanical Thrombectomy with Rotarex System in Buerger's Disease.
Kilickesmez O, Oguzkurt L
J Clin Imaging Sci. 2015 Mar 4;5:14.

We report the case of a patient with 2-month history of chronic thromboembolism of the distal superficial femoral and popliteal arteries with diagnostic features of thromboangiitis obliterans disease. The occlusion could not be crossed by antegrade approach and was achieved retrogradely via dorsalis pedis artery puncture followed by mechanical removal of the thrombus with Rotarex system (Straub Medical AG, Wangs, Switzerland). Subsequent ballooon angioplasties achieved exclusion of the thrombus, and straight-line flow established to the foot through the anterior tibial Artery. The present case report demonstrates the success of mechanical thrombectomy in a patient with Buerger's vasculitis.
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NewsBot · Sep 20, 2016

Hyperbaric Oxygen Therapy in the Treatment of Fontaine Stage IV Thromboangiitis Obliterans
Dogus Hemsinli et al
International Journal of Lower Extremity Wounds September 19, 2016

Ischemic wounds unresponsive to standard treatment in thromboangiitis obliterans are associated with amputation, morbidity, and mortality. In this study, hyperbaric oxygen therapy was added to standard treatment of 36 patients with thromboangiitis obliterans with ischemic ulcerated wounds in the extremities. Full recovery was observed in 52.7% of cases (25% at discharge, 27.7% during follow-up). Resting pain after treatment decreased significantly compared to pretreatment levels based on visual analog scale scores (7.1 ± 1.7 vs 2.2 ± 3.0, P = .0001). Mean wound area also decreased significantly after treatment (22.6 ± 17.5 vs 13.02 ± 16.5, P = .0001). The number of patients requiring no assistance during routine daily activities increased significantly (25% vs 55.5%, P = .001). All patients were at Fontaine stage IV before hyperbaric oxygen therapy. The number of patients at stage IIB increased significantly after treatment, while that of patients at stage IV decreased significantly (0% vs 47.2%, P = .0001, and 100% vs 47.2%, P = .0001, respectively). None of our patients was able to walk without pain before treatment; however, walking distance was significantly extended in 16 patients who were capable of walking (0 vs 190.6 ± 129.4 meters, P = .0001). In addition, 11.1% of patients underwent major amputation during follow-up.
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NewsBot · Dec 10, 2016

Thromboangiitis obliterans (Buerger's disease): state of the art
Zerbino DD
Angiol Sosud Khir. 2016;22(4):185-192.

Thromboangiitis obliterans (Buerger's disease) is systemic vasculitis with predominant development of thrombotic occlusions of small-to-medium diameter arteries of distal portions of both upper and lower limbs. A distinctive feature of Buerger's disease from other vasculitides is the involvement of the venous bed into the pathological process in the form of migrating thrombophlebitis. The disease is encountered more often in young adult males, predominantly tobacco smokers. The clinical pattern is presented by symptoms of increasing insufficiency of blood supply of tissues of extremities. The diagnosis is made by means of ruling out other vascular diseases (atherosclerosis, diabetes mellitus, systemic diseases of connective tissue, hypercoagulation conditions) based on clinical and laboratory findings, as well as modern methods of visualization, including multislice spiral computed tomographic angiography. Of special importance is a pathomorphological examination aimed at detecting the signs specific for Buerger's disease: arteries showing intimal hyperplasia (from stenosis to complete obliteration according to the capillary angiomatosis type, vascular "recalibration", obliteration of lumens by thrombi, lack of calcification of the tunica media; venous alterations are presented by panphlebitis with intimal hyperplasia, and occlusion with thrombi. Treatment is aimed at eliminating the aetiological stimulus (i. e, smoking), improving blood circulation by means of regular, dosed physical exercises, and administration of anti-ischaemic agents (analogues of prostaglandins, calcium channel antagonists, antiaggregants and anticoagulants). Failure of conservative treatment failed should be followed by making a decision to perform revascularization (endovascular interventions, bypass reconstructive operations, arterialization of the venous blood flow of the foot, resection of the posterior tibial veins, transplantation of the greater omentum onto the crus).
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NewsBot · Oct 12, 2018

Clinical outcomes of extended endovascular recanalization of 16 consecutive Buerger's disease patients.
Kacmaz F et al
Vascular. 2018 Oct 10:1708538118805623

Objective Buerger's disease is one of the worst diseases causing peripheral artery occlusions (especially lower extremity) with increased morbidity and mortality. Endovascular treatment of the diseased arteries gains preference over bypass surgery nowadays. Here, we aimed to present the clinical outcomes of 16 consecutive Buerger's disease patients underwent extended endovascular recanalization which is a new technique to restore direct blood flow to at least one foot artery, with the performance of angioplasty for each tibial and foot artery obstructions. Methods A total of 16 consecutive patients with confirmed diagnosis of Buerger's disease that percutaneously treated in our center between February 2014 and March 2018 were included in the study. The mean age of the patients was 44.25 ± 4.28 ranging from 36 to 50 years. After physical examination and complementary diagnostic tests, performance of extended angioplasty for occluded arteries was intended to restore direct blood flow to at least one of the blow-the-knee arteries. Results A successful extended endovascular treatment was performed in 20 of 22 limbs, achieving a technical success of 91%. All patients were successfully discharged without any complication. Mean follow-up duration was 21.43 ± 7.08 months. Reintervention was performed in one patient and minor amputation was needed in one of the failed limbs. Limb salvage rate was 100%. A significant difference was observed based on Rutherford classification, ankle brachial index, direct blood flow to foot, presence of ulcer and rest pain when compared before and after the intervention. Conclusion We showed successful extended endovascular recanalization of Buerger's disease patients with a high technical success rate and sustained clinical improvement. Extended endovascular recanalization could be a therapeutic option in Buerger's disease patients, since they are not good candidates for surgery.
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NewsBot · Jul 26, 2023

Buerger's Disease - A Clinical Case
Urânia Fernandes et al
Port J Card Thorac Vasc Surg. 2023 Jul 7;30(2):59-61

Buerger's disease is a distal segmental nonatherosclerotic vasculopathy that involves the inferior and superior limbs of smoker males younger than 45 years old. This article aims to describe a clinical case and revise the literature about Buerger's disease. A 45-year-old smoker male repeatedly visited the emergency department for refractory pain and inflammatory signs in the right hallux. After developing ulcers in the right foot, Doppler ultrasonography revealed segmental occlusion of distal arteries of that limb. It was also observed in arteriography "corkscrew" collaterals. Autoimmune, thrombophilic and cardiovascular diseases were excluded. Analgesia, antibiotics and alprostadil were implemented. As a result, the patient stopped smoking and was submitted to minor amputation with complete healing, after which he remained asymptomatic. Buerger's disease is a diagnosis of exclusion. Therefore, smoking cessation is the most effective treatment and is crucial to prevent disease progression.
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NewsBot · Aug 15, 2023

Tobacco causes Buerger’s disease

NewsBot · Sep 5, 2023

Successful lumbal sympathetic block as an alternative therapy for improving Buerger's disease: A rare case report and literature review
Hariadi Hatta et al
Int J Surg Case Rep. 2023 Sep 1;110:108778

Introduction and importance: Buerger's disease is an inflammation of blood vessels that is strongly related to smoking habits. Lumbal sympathetic block is one kind of lumbal sympathectomy intervention that is used to manage chronic pain, including Buerger's disease. In this case report, we present the case of a Buerger's disease patient treated with a lumbal sympathetic block procedure.

Case presentation: A 63-year-old male was referred to our emergency room with chronic pain and ulcers on his left foot. He had already undergone two debridement procedures at his previous hospital without any improvement. After a comprehensive assessment, our cardio-thoracic specialist chose to refer the patient to undergo the lumbal sympathetic block with the orthopaedic specialist. After two procedures, we found a reduction in pain (VAS 6-7 to 2-3), the skin looked more colored, and the patient's walking distance improved from 10 to 100 m without any complaints. We also found good wound healing of the ulcers in his left foot; they became smaller and dryer.

Clinical discussion: Lumbal sympathetic block is thought to be able to reduce peripheral retention that causes the opening of an arteriovenous anastomose, thus increasing blood flow to skin tissue and leading to vasodilatation. It showed its capability to prevent Buerger's disease progression, reduce patient complaints, and heal the wound.
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Thromboangiitis obliterans

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