THROMBOANGIITIS OBLITERANS



Thromboangiitis obliterans or Buerger’s disease is an inflammatory process causing obliteration of peripheral arteries and veins. Men are affected much more frequently than women, and it usually occurs before age 30. Its etiology is not fully understood, but a relationship to cigarette smok­ing is suspected. Like arteriosclerosis obliterans, the lesions are often segmental, but smaller arter­ies are involved. The pathology consists of intimal proliferation and thrombi in small to medium-sized vessels with inflammatory infiltrates. The process may alternate between periods of activity and quiescence, and peripheral ischemia devel­ops gradually over the course of a few years. In its later stages, it may be difficult to differentiate from arteriosclerosis obliterans. The lower ex­tremities are commonly affected, but involvement of the upper extremities is more common than in arteriosclerosis obliterans. The patient is often a cigarette smoker who complains of cold extrem­ities and may manifest digital ulcers and Ray­naud’s phenomenon. Up to half of the patients have a history of migratory thrombophlebitis. In­volvement of the lower extremity may produce claudication, gangrene, ulcers, and rest pain sim­ilar to arteriosclerosis obliterans, but obstruction is usually moredistal (instep or hand claudication is characteristic). Occasionally the coronary, cer­ebral, mesenteric, or, renal arteries are involved. The diagnosis can be suspected by the character­istic clinical findings in a young male and is proven by biopsy of an involved artery.

Patients may do well for long periods of time, but the need for amputation of distal extremities is common if patients continue to smoke. No med­ication has been shown to be helpful. Sympa­thectomy to prevent vasospasm may be effective if conservative therapy fails.