What is Obliterating Thromboangiitis (Buerger’s Disease)?
Thromboangiitis obliterans (OT) is a systemic inflammatory disease of medium-sized vessels (arteries and veins) with a primary lesion of the vessels of the extremities.
Epidemiology
Not studied. Mostly middle-aged men are ill.
Pathomorphology
Segmental vascular lesion is characteristic. At the same time, various stages of the development of the pathological process are observed: from inflammatory polymorphic cell infiltration of the vessel wall with thrombus formation to vessel fibrosis.
Causes of Obliterating Thromboangiitis (Buerger’s Disease)
Among the reasons for the development of OT are smoking abuse and genetic factors. In the pathogenesis of OT, various immune and microcirculatory disorders that contribute to the development of thrombovasculitis are important.
Symptoms of Obliterating Thromboangiitis (Buerger’s Disease)
The most common initial signs of the disease are intermittent claudication when walking, migratory thrombophlebitis and, less commonly, signs of ischemia in the toes. In the future, the symptoms of arterial insufficiency increases, half of the patients develop Raynaud’s syndrome and signs of vascular insufficiency in the upper limbs. In a number of patients, coronary and cerebral vessels are involved in the pathological process.
Diagnosis of Obliterating Thromboangiitis (Buerger’s Disease)
Laboratory data are not specific. Indicators of inflammatory and immune activity are not determined.
Diagnosis. The absence of characteristic clinical and laboratory signs complicates the diagnosis. However, when there are complaints of intermittent claudication in men 40-50 years old, malicious smokers can think about OT. Angiography determines the segmental symmetric narrowing of the vessels, which distinguishes these changes from the atherosclerotic process, which is characterized by asymmetry and diffuse lesion throughout the vessel.
Differential diagnosis. The disease is differentiated from obliterating atherosclerosis, which usually begins at a later age, vascular damage is characterized by an asymmetric, slow increase in the symptoms of ischemia and the presence of an atherosclerotic process in other vessels. In the presence of Reino syndrome, OT must be distinguished from other vasculitis and DBST.
Treatment of Obliterating Thromboangiitis (Buerger’s Disease)
Combined treatment of OT with vasodilating and antithrombotic drugs prescribed for a long time is recommended. Among the drugs of choice can be called prodectin, compliance, stugsron, andskzlnn, derivatives of nicotinic acid. In case of lipid metabolism disorders, drugs normalizing fat metabolism are indicated.
In connection with the presence of immune manifestations, a long-term administration of aminoquinoline derivatives is indicated. If necessary, reconstructive therapy is performed – prosthetics of the most affected parts of the vessels.
In the presence of systemic manifestations, heparin and antiplatelet agents are mandatory.