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Buerger's Disease
Buerger's disease or thromboangitis obliterans is a disease that affects the arteries and veins and can lead to their eventual occlusion. This disease was first described by Dr. Buerger in 1908. The cause of this disease remains unknown. The vascular lesions (inside the walls of the blood vessels) appear to be inflammatory, but the actual cause for Buerger's has been the topic of much speculation. Immunologic, toxic, and infectious causes have been postulated. Many of the patients who suffer from
this disease are smokers which has lead to the implication that nicotine as at least an exacerbating factor for Buerger's disease. Males are affected more frequently than females in a ratio of approximately 75 to 1. Incidence of this disease is approximately 7 or 8 cases per 100,000 in the general population. For unknown reasons this disease is more common in the Orient. The typical patient with Buerger's disease is a young male who smokes cigarettes and presents with the signs and symptoms of peripheral vascular disease. The lower extremities are most commonly affected and patients will often complain of coldness of the limbs. Leg pain with exercise (claudication) that progresses to pain at rest is common. The upper extremities can be involved in up to 70% of patients with Buerger's and patients will often have symptoms of Raynaud's disease. Increased sweating of the hands and finger ulcers are also seen. Peripheral vascular disease can be confirmed with angiodynography or angiogram. Diagnosis is made by tissue biopsy (specimen) of the affected blood vessel. Patients will also have their cholesterol checked in addition to a glucose tolerance test (diabetes screen) to exclude atherosclerosis, a more common cause of vascular occlusive disease.
Treatment includes strict avoidance of any tobacco products. This includes exposure to secondary smoke from other smokers. A surgical procedure to sever the sympathetic nerves (autonomic nerves) has also been used. Prognosis for life is good but amputation of the lower extremities is common in advanced disease.
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