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Essentials of Diagnosis
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Typically occurs in men who smoke cigarettes
Distal extremities involved with severe ischemia progressing to tissue loss
Thrombosis of the superficial veins may occur
Smoking cessation is essential to stop disease progression
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General Considerations
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Thromboangiitis obliterans (Buerger disease) is a segmental, inflammatory, and thrombotic process of the most distal arteries and occasionally veins of the extremities
Cause is unknown but condition is rarely seen in patients who do not smoke cigarettes
Pathologic examination reveals arteritis in affected vessels
Arteries most commonly affected are the plantar and digital vessels of the foot and lower leg
In advanced stages, the fingers and hands may become involved
Progression of disease seems to be intermittent with acute and dramatic episodes followed by some periods of remission
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Lesions on the toes in a patient < 40 years old
Superficial thrombophlebitis may aid in differentiating from atherosclerotic peripheral vascular disease (PVD)
Rest pain, particularly in the toes
Pain often progresses to tissue loss and amputation, unless patient stops smoking
Intermittent claudication is not common
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Differential Diagnosis
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PVD
Tissue ischemia tends to be less dramatic in PVD than in thromboangiitis obliterans
Also in PVD symptoms of proximal arterial involvement (eg, claudication) predominate
Raynaud disease
Repetitive atheroemboli
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Therapeutic Procedures
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Smoking cessation is mainstay of therapy and will halt disease in most cases
Revascularization is not often possible as the distal arterial tree is occluded
Intra-arterial infusion of prostacyclin analogs has been reported to improve ulcer healing in some cases
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Cacione
DG
et al. Pharmacological treatment for Buerger's disease. Cochrane Database Syst Rev. 2020;5:CD011033.
[PubMed: 32364620]
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Le Joncour
A
et al; French Buerger's ...