Buerger's Disease / Thromboangitis obliterans

Question 1

What is thromoboangitis obliterates?

Answer 1

Inflammatory occlusive thrombosis of small and medium sized arteries and some superficial veins usually in the distal and upper extremities

Question 2

Who is affected by TO?

Answer 2

• Occurs almost exclusively in tobacco users
• Usu males 20-40y
• Asia, Far East, Middle East

Question 3

Which genotypes are associated with TO?

Answer 3

HLA-A9

HLA-B5

Question 4

What occurs in acute thromboangitis obliterates?

Answer 4

• occlusive thrombi accompany neutrophilic and lymphocytic infiltration of intima
• endothelial cells proliferate
• internal elastic lamina remains intact

Question 5

What occurs in intermediate TO?

Answer 5

Thrombi organise and reconciles incompletely.

-media preserved but may be infiltrated by FBs

Question 6

What causes TO?

Answer 6

Exact mechanisms unkown:

• cigarette smoking primary risk factor
• may involve DTH or toxic angitis or
• cell mediated sensitivity to collagen I and III (in blood vessels)

Question 7

What are the CFx of TO?

Answer 7

Triad of:

• claudication of affected extremity (+/- trophic / ischaemic changes)
• Raynaud’s
• migratory superficial thrombophlebitis

Question 8

Where does claudication occur in TO and why?

Answer 8

-Lower calves and feet
-forearms and hands
TO affects distal vessels

Question 9

What is demonstrated on angiography in TO?

Answer 9

• segmental occlusion of distal arteries of hands and feet
• torturous, corkscrew collateral vessels around occlusions
• no atherosclerosis

Question 10

How can TO/Buerger’s be diagnosed?

Answer 10

Clinically + exclude other causes.

• Hx and PEx
• ABI suggests ischaemia
• Echo excludes cardiac emboli
• Bloods exclude vasculitis, and antiphospholipid Ab syndrome
• angiography shows characteristic findings

Question 11

Treatment of Buerger’s

Answer 11

No specific treatment except abstention from tobacco