From the Guidelines
Thromboangiitis obliterans (Buerger disease) is a rare arterial obliterative and thrombotic process that primarily affects young individuals, and its diagnosis and treatment involve a comprehensive approach, including smoking cessation, which is critical due to the presumed causative role of tobacco in the pathogenesis of this syndrome.
Diagnosis
The diagnosis of Thromboangiitis obliterans (Buerger disease) is based on a combination of clinical presentation, laboratory tests, and imaging studies.
- Clinical presentation: The disease typically presents with symptoms such as claudication, pain at rest, and ulceration or gangrene of the affected limb 1.
- Laboratory tests: There are no specific laboratory tests for Buerger disease, but tests such as complete blood count, erythrocyte sedimentation rate, and C-reactive protein may be used to rule out other conditions 1.
- Imaging studies: Angiography is the most useful imaging study for diagnosing Buerger disease, as it can show the characteristic segmental occlusions and corkscrew collaterals 1.
Treatment
The treatment of Thromboangiitis obliterans (Buerger disease) is primarily focused on smoking cessation, as continued tobacco use is associated with a particularly adverse outcome 1.
- Smoking cessation: This is the most critical aspect of treatment, as tobacco use is thought to play a causative role in the disease 1.
- Pharmacological interventions: Medications such as nicotine replacement therapy, bupropion, and varenicline may be used to aid in smoking cessation 1.
- Other treatments: Other treatments, such as antiplatelet agents, vasodilators, and prostaglandin analogs, may be used to manage symptoms and prevent disease progression, but their effectiveness is limited 1. It is essential to note that the treatment of Buerger disease is challenging, and the disease can lead to significant morbidity and mortality if left untreated or if smoking cessation is not achieved 1.
From the Research
Diagnosis of Thromboangiitis Obliterans (Buerger Disease)
- The diagnosis of Buerger's disease is based on clinical and angiographic criteria, including a smoking history, onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, and absence of atherosclerotic risk factors other than smoking 2.
- The traditional diagnosis of Buerger's disease requires the fulfillment of 5 criteria, although this is not universally accepted 2.
- Angiographic findings in Buerger's disease, such as "corkscrew," "spider legs," or "tree roots," are helpful but not pathognomonic 2.
- The clinical criteria for Buerger's disease include age under 45 years, current or recent history of tobacco use, presence of distal-extremity ischemia, and exclusion of autoimmune diseases, hypercoagulable states, and diabetes mellitus 3.
Treatment of Thromboangiitis Obliterans (Buerger Disease)
- Total abstinence from tobacco use is the only means of stopping the disease progression 2, 3, 4.
- The initial management of patients with Buerger's disease should be conservative, with claudicants encouraged to walk and patients with "critical" ischemia admitted for bed rest in the hospital 2.
- Bypass grafting is seldom an option, as the location of the lesions distally leaves little to bypass due to lack of target vessels 2.
- Induced hypervolemia and prostacyclins are effective treatments of critical limb ischemia in Buerger's disease 5.
- New therapeutic options, such as stem cell-derived therapies, immunoadsorption, and the endothelin-receptor-blocking agent bosentan, are being explored 6.
- Therapeutic angiogenesis has demonstrated excellent collateral blood vessel formation and clinical improvement in patients with Buerger's disease 4.