Obliterative thromboangiitis

What is thromboangiitis obliterans?

Thromboangitis obliterans is a smoking-related condition that causes blood clots to form (thrombosis) in small and medium-sized arteries, and less frequently in veins. The affected areas are most commonly the hands and feet. Thromboangitis obliterans is also known as Buerger's disease.

Who gets thromboangiitis obliterans?

Thromboangitis obliterans occurs almost exclusively in smokers. It is most common in Eastern Europe, the Middle East and Asia. Most patients are between 20 and 45 years old and consume homemade cigarettes. the incidence appears to have declined in recent years as smoking has declined. US statistics estimate approximately 10-20 cases per 100,000.

Thromboangitis obliterans has also been reported to affect long-term cannabis smokers.

What are the symptoms of thromboangitis obliterans?

The most common presentation of thromboangitis obliterans is painful purple/blue areas on the fingers and toes (blue toe). syndrome) It is often unilateral and may involve isolated fingers or toes. The pain is often worse at night, with exercise, and in cold weather. Over time, the areas may ulcerate or turn black secondary to the death of the affected skin (gangrene) The disease progresses in patients who continue smoking and can lead to complete loss of digits or limbs On examination, the pulses of hands and feet are often lost at an early stage. Other associated problems may include recurrent venous thrombosis (superficial or deep veins), erythema gnarled, and rarely affects the blood supply to internal organs such as the kidneys, heart, and brain.

What causes thromboangiitis obliterans?

The cause of thromboangiitis obliterans is not fully understood, but smoking is likely to trigger thrombosis in the blood vessels, leading to a lack of oxygen and nutrients to the affected tissue. Research has shown the presence of immunoglobulins and endothelial cell antibodies suggesting a immune mechanism. The blood level of these antibodies can be used as a marker of disease activity. The response to acetylcholine (a chemical that leads to relaxation of blood vessels) has also been shown to decrease patients with thromboangitis obliterans compared to normal subjects.

In some cases, thromboangiitis obliterans has been associated with chronic arsenic poisoning.

What tests are necessary for thromboangitis obliterans?

A skin biopsy may be helpful, although the features are not specific for thromboangiitis obliterans. the histology usually shows intraluminal thrombosis (a blood clot within the vessel) with associated microabscess training. A mix infiltrate of white blood cells and giant cells can be seen in all layers of the vessel wall, although the internal elastic lamina is classically preserved and helps distinguish thromboangiitis obliterans from other types of vasculitis.

Tests to rule out the presence of other diseases such as diabetes, bleeding disorders, connective tissue disease, atherosclerosis and embolism are usually performed.

A scan of the arteries in the extremities (arteriography) may be done and will likely show normal proximal vessels (these are closest to the body) but multiple distal narrowings and occlusions (closest to the hands and feet). Many new bypass vessels (corkscrew collaterals) often develop in an attempt to maintain blood supply.

How is thromboangiitis obliterans treated?

• Of smoking cessation is essential.
• Hands and feet should be kept warm and protected from trauma and infection.

Although a single treatment is not considered definitive, an intravenous infusion of Iloprost (a medication that helps you relax) should be considered. blood vessel walls and reduce coagulation), sympathectomy (ablation of the nerves causing blood vessels constriction), and removal of gangrenous tissue may be necessary.

There is little evidence that systemic Steroids or anticoagulants are helpful.