Buerger's disease

Buerger's disease  Buerger's disease is a thromboangiitis obliterans
 is thromboangiitis obliterans - narrowing of the veins and arteries of medium and small size in the upper and lower extremities as a result of the inflammatory process. In rare cases, the pathology seen in the coronary, cerebral and visceral arteries.

The disease has been described by German physician Leo Burgess in 1908, conjectured that it was the cause of the disease they carried out 11 amputations.

Traditionally, Buerger's disease prone, mostly male smokers aged 20-40 years. However, in recent years, cases of diagnosing the disease in women, due to the spread of smoking among the fairer sex.

Despite the assumption of experts, the etiology of the disease is not fully understood: there are indications regarding the impact on the patient's genetic factors, in particular the carrier antigen HLA - B5 and the A9, as well as the presence of patients with antibodies against laminin, elastin and collagen I, III and IV.

The clinical picture of Buerger's disease

Pathomorphological there is a gradual decline in the circulation of the hands or feet, starting from the distal portions (fingertips) and extending proximally (top). Inflammation of the arteries characterized by cell-infiltrative processes in all three layers of the vessel wall: intimal lesion, splitting of cell membranes, endothelial hyperplasia and severe thrombosis.

There are two main forms of destruction: peripheral and mixed. The first form of Buerger's disease affects the blood vessels, or major arteries of limbs with characteristic symptoms of arterial ischemia of the legs, migrating thrombophlebitis, acrocyanosis, the formation of ulcers. When mixed form along with evidence of vascular lesions of the limbs have symptoms of heart disease, blood vessels of the brain, kidney, lung abnormalities, abdominal symptoms.

In the initial period of Buerger's disease are observed functional changes in the extremities: feet coldness, numbness, sensations of "pins and needles." Patients report a loss of feeling in the fingers, blue and pain. If it affects the vessels of the legs appears a symptom of intermittent claudication - sharp pain in the calf muscles during walking.

Against the background of Buerger's disease can be observed trophic disorders: rash, anhidrosis, hyperpigmentation, edema, skin atrophy, muscle necrosis, trophic ulcers, gangrene.

Diagnosis of Buerger's disease

Often the diagnosis of Buerger's disease is exclusive character (in cases where the proof of the impossibility of the existence of other diseases when the above symptoms). The diagnosis of thromboangiitis obliterans can be put under the following aspects:

  • Patient age younger than 40-45 years old;
  • Signs of insufficient blood circulation in the tissues of the extremities with pain, claudication, ulcers detected by non-invasive methods (eg, ultrasound Doppler effect);
  • Exclusion of diseases associated with bleeding disorders, autoimmune diseases, diabetes;
  • Pathological processes of a similar nature identified in the patient and in apparently healthy limb.

In respect of functional tests that would indicate a violation of the blood supply to the extremities, use the following:

  • Symptom plantar ischemia Oppel (blanching lifted up the affected limb);
  • Sample Goldflama (the patient in the supine position performs exercises for flexion and extension of the knee and hip joints. When expressed violations bloodstream patient feels tired after 10 manipulation);
  • Knee Panchenko phenomenon (the patient in the sitting position, threw back his injured leg to a healthy, he begins to experience numbness, pain in the affected limb).

Treatment of Buerger's disease

Currently, effective therapies Buerger's disease does not exist. In the early stages of obliterating  Buerger lower limbs
 thromboangitis specialists recommend to carry out conservative treatment associated with:

  • Eliminating the impact of the disease on the etiological factors (eg, smoking cessation);
  • Pain relief;
  • Eliminate spasm of vessels using ganglioblokatorov and antispasmodics;
  • Normalization of blood clotting, improving its rheological properties;
  • Improvement of metabolic processes in the tissues.

In the absence of a positive effect from conservative therapy there are prerequisites for the conduct of the operation. In order to remove peripheral arterial spasm surgeons performed lumbar sympathectomy. In the case of involvement in the pathological process of blood vessels of the upper limbs performed thoracic sympathectomy. There is also information on the positive impact on the course of Buerger's disease hyperbaric oxygenation and plasmapheresis, however, these methods are not generally accepted.

The effectiveness of alternative methods of treatment Buerger's disease, clinical trials are taking place - the injection of stem cells - is not yet officially confirmed.

The appearance of necrosis and gangrene of the affected limb is an indication for amputation. According to statistics, about 35% of patients with this diagnosis, you can not avoid the surgical removal of the limbs.

Recommendations

A person suffering from Buerger's disease should immediately quit smoking - otherwise the disease will progress only. In addition, the patient should avoid skin damage due to exposure to high or low temperatures, chemicals, injuries related to wearing uncomfortable shoes, holding small operations (for example, removal of calluses), fungal infections.

All patients (except in patients with presence of ulcers and gangrene of the affected limbs) recommended a brief walk (20-30 minutes) several times a day.





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