12 Questions
What is the trend in the prevalence of Buerger disease over the past 5 years?
It has diminished
Which population has the highest incidence of Buerger disease?
Israeli Jews of Ashkenazi descent
What is the male-to-female ratio of Buerger disease?
3:1
What is a characteristic of the chronic phase of Buerger disease?
A decrease in hypercellularity and frequent recanalization of the vessel lumen
What is a distinctive feature of Buerger disease compared to atherosclerosis?
Infiltration of round cells in all 3 layers of the arterial wall
What is required for a precise diagnosis of Buerger disease?
Tissue histology
What is the age range in which Buerger disease most commonly occurs?
20 to 50 years
What is the primary cause of Buerger disease in most patients?
Smoking
What is the significance of migratory superficial phlebitis in Buerger disease patients?
It indicates a systemic inflammatory response.
What is the primary goal of treatment for Buerger disease?
To promote strict smoking cessation
What is the role of surgical intervention in Buerger disease?
It is often not possible due to a lack of suitable target vessels
What is the term for the phenomenon characterized by ischemic rest pain and ulcerations on the toes, feet, or fingers?
Raynaud phenomenon
Study Notes
Buerger Disease (Thromboangiitis Obliterans)
- A progressive, nonatherosclerotic, segmental, inflammatory disease affecting small and medium arteries of the upper and lower extremities
- Typically affects people between 20 to 50 years old, with men being more frequently affected, especially smokers
Clinical Presentation
- Patients initially present with claudication in the foot, leg, arm, or hand, which may be mistaken for joint or neuromuscular problems
- Progression of the disease leads to calf claudication, ischemic rest pain, and ulcerations on the toes, feet, or fingers (Raynaud phenomenon)
- Migratory superficial phlebitis can be present in up to 16% of patients, indicating a systemic inflammatory response
Treatment and Prognosis
- Strict smoking cessation is key to treatment, with impressive disease remission in patients who abstain from smoking
- Surgical intervention is minimal due to the lack of acceptable target vessels for bypass and limited autogenous vein conduits
- Amputation avoidance is increased in patients who quit smoking
- Morbidity is substantial, with 43% of patients requiring 1 or more amputations in 7.6 years if they continue to smoke
Epidemiology
- The prevalence of Buerger disease has decreased over the past 5 years due to decreased smoking and stricter diagnostic criteria
- Highest incidence occurs in Israeli Jews of Ashkenazi descent and natives of Indian, Korean, and Japanese ancestry
- Less frequent in subjects of northern European descent
- Death from TAO is unusual, but morbidity is substantial
Pathophysiology
- Thrombosis occurs in small to medium arteries and veins with associated dense polymorphonuclear leukocyte aggregation, microabscesses, and multinucleated giant cells
- Chronic phase shows a decrease in hypercellularity and frequent recanalization of the vessel lumen
- End-stage lesions demonstrate organized thrombus and blood vessel fibrosis
- Patients with Buerger disease may have specific cellular immunity against arterial antigens, specific humoral anti-arterial antibodies, and elevated circulatory immune complexes
History and Physical
- Pathologically, Buerger disease is manifested by the infiltration of round cells in all 3 layers of the arterial wall, unlike atherosclerosis which involves the intima and media
- A precise diagnosis can be made only by tissue histology
Learn about Buerger disease, a progressive inflammatory disease affecting small and medium arteries, its history, and typical age range of occurrence.
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