Buerger's Disease

AKA: Thromboangitis obliterans
- non-atherosclerotic, segmental inflammatory disease that affects small and medium sized arteries and veins of the extremities.
- affected patients are almost uniformly smokers to the point where somking is more or less a pre-requisite for this diagnosis.

Presentation:
- ischemia of distal small arteries and veins
- claudication of distal extremities, two or more limbs always involved
- differentiate from claudicants who have calf cramping typically
- progression leads to ischemic rest pain and ulceration of fingers and toes

Diagnosis:
- rule out: scleroderma, CREST, mixed connective-tissue disease, SLE, hypercoaguability disorders with serum screens (CBCD, lytes, BUN, Cr, LFTs, BG, UA, sed rate, CRP, hypercoagubility screen incl APAb, ANA, RF, Complement, SCL-70, anticentromere Ab)
- angiography (MRA or CTA) may be needed
- echo to rule out proximal embolic source

Treatment:
- stop smoking!!
- limited options if arterial occlusion has developed +/- ulceration
- calcium channel blockers may be useful if pt has developed Raynaud's phenomenon
- Revascularization is not an option as distal targets and saphenous conduits are toast
- Although graft patency rates are low if targets are available, if it heals ulcer usually results in high rate of limb salvage.
- Amputations inevitable in pts with extensive gangrene or sepsis