Thromboangiitis Obliterans (Buerger Disease)
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- Nonatherosclerotic vasculitis of small- and medium-sized arteries and veins resulting in segmental occlusion
- Characterized clinically by an inflammatory and vaso-occlusive phenomenon, rest pain, unremitting ischemic ulcerations, and gangrene of the digits of hands and feet
- Occurs primarily in men who smoke
- System(s) affected: Cardiovascular
- Synonym(s): Buerger disease
- The prevalence has decreased in North America over the last 30 years.
- Worldwide, but most prevalent in Eastern Europe, Mediterranean, and Asian countries
- 11–30/100,000 persons/year
- Predominant age: 20–40 years
- Predominant sex: Male > Female; increasing numbers of women are being diagnosed, possibly due to increased smoking (1).
- Estimates range from as low as 0.5–5.5% in Western Europe, to 45–63% in India, to 80% in Israel among Jews of Ashkenazi ancestry.
- Accounts for 5% and 16% of patients hospitalized for arterial occlusive disease in Europe and Japan, respectively
- 13/100,000 US population
- Overall occurrence is decreasing worldwide (2).
Not common in this age group
Should be considered in the differential diagnosis of the young patient with claudication.
- Smoking tobacco, with rare cases with smokeless tobacco/snuff. The degree of dependence is similar to that in subjects with coronary artery disease.
- Chronic anaerobic periodontal infection also may play a role in the development of Buerger disease.
- Greater prevalence of HLA-A54, HLA-A9, and HLA-B5
- HLA-B12 antigen may be associated with disease resistance.
- Familial cases reported rarely
Never smoke. Tobacco and smoking cessation is the only way to prevent Buerger disease.
- Impaired endothelium-dependent vasorelaxation and decreased peripheral sympathetic outflow
- Segmental infiltration of inflammatory cells in vessel wall leads to thrombotic occlusion of vessel.
- Highly cellular and inflammatory thrombus with relative sparing of the blood vessel wall
- Genetic factors
- Autoimmune disorder with cell-mediated sensitivity to types I and III human collagens (both are normal constituents of blood vessels)
- Impaired peripheral endothelium-dependent vasodilation. Nonendothelial mechanisms of vasodilation are intact.
- Arsenic content of tobacco
- Chronic anaerobic periodontal infection