:<3:Thromboangiitis obliterans (Buerger’s disease) is a nonatherosclerotic, segmental, recurrent inflammatory disorder of the small- and medium-sized arteries and veins of the upper and lower extremities.
:<3:Incidence:The disease occurs mostly in young men (less than 45 years of age) with a long history of tobacco and/or marijuana use and chronic periodontal infection, but without other CVD risk factors (e.g., hypertension, hyperlipidemia, diabetes)
:<3:Patho: In the acute phase of Buerger’s disease, an inflammatory thrombus forms and blocks the vessel. Over time, the thrombus becomes more organized and the inflammation subsides. During the chronic phase, thrombosis and fibrosis occur in the vessel, causing tissue ischemia.
:<3:**The symptoms of Buerger’s disease often are confused with PAD and other autoimmune diseases (e.g., scleroderma).
:<3: S&S: intermittent claudication of the feet, hands, or arms. As the disease progresses, rest pain and ischemic ulcerations develop, color and temperature changes of the limbs, paresthesia, superficial vein thrombosis, and cold sensitivity.
:<3:Diagnostics: no laboratory or diagnostic tests specific to Buerger’s disease. Diagnosis is made based on age of onset; history; clinical symptoms; involvement of distal vessels; presence of ischemic ulcerations; and exclusion of autoimmune disease, diabetes, thrombophilia (inherited tendency to clot), and other source of emboli.
:<3:**Treatment: The main treatment for Buerger’s disease is the complete cessation of tobacco and marijuana use in any form. Use of nicotine replacement products is contraindicated. Patients must choose between their tobacco or marijuana and their affected limb, but not both. Conservative management includes avoiding limb exposure to cold temperatures, a supervised walking program, antibiotics to treat any infected ulcers, and analgesics to manage the ischemic pain. Teach patients to avoid trauma to the extremities. IV iloprost this has been shown to improve rest pain, promote healing of ischemic ulcers, and decrease the need for amputation. Surgical options include sympathectomy (transection of a nerve, ganglion, and/or plexus of the sympathetic nervous system), implantation of a spinal cord stimulator, and bypass surgery. improve distal blood flow and reduce pain, but neither alters the inflammatory process. Painful ulcerations may require finger or toe amputations.