Buerger's disease is a recurring inflammation of the small and intermediate arteries and veins in the lower extremities caused by an unknown autoimmune vasculitis. It most commonly affects smoking males ages 20-35 and symptoms include foot and calf pain with claudication, skin changes, ulcers, and gangrene. Diagnosis involves duplex scanning and arteriograms showing classic corkscrew arteries. Treatment focuses on complete tobacco cessation as no other therapies have proven effective, with amputation as a last resort for severe cases.
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Buerger's disease is a recurring inflammation of the small and intermediate arteries and veins in the lower extremities caused by an unknown autoimmune vasculitis. It most commonly affects smoking males ages 20-35 and symptoms include foot and calf pain with claudication, skin changes, ulcers, and gangrene. Diagnosis involves duplex scanning and arteriograms showing classic corkscrew arteries. Treatment focuses on complete tobacco cessation as no other therapies have proven effective, with amputation as a last resort for severe cases.
Buerger's disease is a recurring inflammation of the small and intermediate arteries and veins in the lower extremities caused by an unknown autoimmune vasculitis. It most commonly affects smoking males ages 20-35 and symptoms include foot and calf pain with claudication, skin changes, ulcers, and gangrene. Diagnosis involves duplex scanning and arteriograms showing classic corkscrew arteries. Treatment focuses on complete tobacco cessation as no other therapies have proven effective, with amputation as a last resort for severe cases.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online from Scribd
Buerger's disease is a recurring inflammation of the small and intermediate arteries and veins in the lower extremities caused by an unknown autoimmune vasculitis. It most commonly affects smoking males ages 20-35 and symptoms include foot and calf pain with claudication, skin changes, ulcers, and gangrene. Diagnosis involves duplex scanning and arteriograms showing classic corkscrew arteries. Treatment focuses on complete tobacco cessation as no other therapies have proven effective, with amputation as a last resort for severe cases.
Copyright:
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BUERGERS DISEASE
Jeaneth Cecilia D. Jurado
DEFINITION Recurring
inflammation of the intermediate and small arteries and veins of the lower extremities Cause is unknown but is believed to be autoimmune vasculitis Most often affect males between the ages of 20-35 Aggravating factor: heavy smoking or chewing tobacco
Generally bilateral and symmetric with focal lesions. Superficial thrombophlebitis may be present rare in the United States, but is more common in the Middle East and Far East The disease though commences peripherally, may gradually extend proximately occluding the larger arteries.
CLINICAL MANIFESTATIONS
Foot claudication and later with calf claudication Gangrene and ulceration may follow Paresthesia, coldness and skin colour changes are common complaints Dependent rubor and slow venous filling are commonly seen Intolerable rest pain Inflammation along a vein just below the skin's surface (due to a blood clot in the vein) Absence of pedal pulse, radial and ulnar pulse Severe cases: cyanosis, ulceration with gangrene
Precipitating factors: cigarette smoking or chewing tobacco
PATHOPHYSIOLOGY
Predisposing factors:
Gender: male leg blood clots Age: 20 35 years old
inflammatory (thrombus formation) pain sensation is diminished changes in the nails and skin appear painful ulcers and gangrene severe impaired blood flow Buergers Disease amputation
DIAGNOSTIC STUDIES DUPLEX SCANNING ARTERIOGRAM
On the left is a normal angiogram. On the right, is an abnormal angiogram of an arm demonstrating the classic corkscrew appearance of arteries to the hand. The changes are particularly apparent in the blood vessels in the lower right hand portion of the picture (the ulnar artery distribution).
TREATMENT AND MANAGEMENT
Absolute discontinuation of tobacco use is the only strategy proven to prevent the progression of Buerger disease. Except for absolute tobacco avoidance, no forms of therapy are definitive. Despite the clear presence of inflammation in this disorder, anti-inflammatory agents such as steroids have not been shown to be beneficial. Similarly, strategies of anticoagulation (thinning of the blood with aspirin or other agents to prevent clots) have not proven effective.
Intravenous iloprost (a prostaglandin analogue) has been shown to be somewhat effective in improving symptoms, accelerating resolution of distal extremity trophic changes, and reducing the amputation rate among patients with Buerger disease. Distal limb amputation - Ultimate surgical therapy for refractory Buerger disease (in patients who continue smoking) for nonhealing ulcers, gangrene, or intractable pain.
Omental transfer - improved skin and muscle microcirculation and forestalled the need for amputation by providing symptomatic relief and clinically arresting the progress of Buerger's disease. Omental transfer should be considered seriously as an alternative to other modalities of therapy to delay the ischaemic complications of Buerger's disease. Antibiotics to treat infected ulcers Palliative treatment of ischemic pain with nonsteroidal and narcotic analgesics
NURSING CARE quit smoking use stress relief like going for walks -orlisten to calming music good nutrition promotes healing and prevents tissue breakdown protein intake physical exercise Use of well-fitting protective footwear to prevent foot trauma and thermal or chemical injury
self-care program should be planned with the patient use of neutral soaps proper wound care gently massage the area to increase the circulation avoid cold temperature avoid sitting and standing for long period do not walk barefooted to avoid injury elevate extremities for better circulation
