Thromboangitis Obliterans (TAO) / Buerger’s Disease

It is the thrombosis and inflammation of the arterial wall with the occlusion of the lumen of the vessels

This is characterized by….

  • Occlusive disease of small and medium sized arteries (plantar, tibial, radial)
  • Thrombophlebitis of the superficial or deep veins 
  • Raynaud’s syndrome
 
 

Cause Of TAO

The cause is unknown


Commonly occurs in male smokers under the age of 40 years in low socioeconomic status

TAO initially affects the toe vessels
               ↓
Gradually involves the plantar and tibial arteries
               ↓
Causes thrombophlebitis of the superficial and deep veins
               ↓
Also causes segamental inflammatory and thrombotic processes of the peripheral arteries and veins,
mostly in the lower limbs
               ↓
Occlusion of the vessels
               ↓
Ischemia, ulceration, gangrene

Histologically, there are inflammatory changes in the walls of arteries and veins,leading to thrombosis


Management Of Thromboangitis Obliterans

Patient profile

  1. Age : Under 40 years
  2. Males smokers are commonly affected
  3. Manual labourers are more affected
  4. Bore footed are more affected
  5. Genetic predisposition may be present (DM, heart disease)


Clinical features

  1. Intermittent claudication
  2. Rest pain
  3. Tissue necrosis leading to gangrene
  4. Coldness, numbness, paraesthesia and change of colour of limbs

Examination

  1. Skin : Dry, shriveled, mummified, blackened, greasy to touch (Dry gangrene)
  2. Ulcer or gangrene is present
  3. Loss of hair
  4. Trophic changes of nail (Become brittle, transverse ridges)
  5. Muscle wasting
  6. Shiny skin
  7. Reduced skin thickness
  8. Diminished sensation
  9. Diminished movements
  10. Decreased or absent arterial pulsation
  11. Delayed venous filling
  12. Areas is cold in respect to the other areas


Investigations

  1. No specific investigations 


Treatment

  1. Avoid smoking
  2. Nutrition supplementation
  3. Care of the limbs
  4. Wearing soft shoes and socks
    • Keeping the feet dry
    • Careful pairing of toe nails
    • Regular exercise within the limit of claudication pain
  5. Buerger’s exercise
    • Rise the limbs for 2 mins and then hang it for next 3 mins for 30 mins for 2 – 3 times a day
  6. Medical treatment
    • Pentoxifylline to increase microcirculation by reducing blood viscosity
    • Cilostazol
    • Low dose aspirin
    • Analgesics for pain
    • Broad spectrum antibiotics
  7. Specific treatment
    • Bilateral lumber sympathectomy
    • It causes cutaneous vasodilation and improve cutaneous circulation and rest pain
    • It does not improve intermittent claudication
    • If it fails amputation
  8. If ulcer present – Treatment for the ulcer
Latest posts by Dr. Pasindu Suriapperuma (see all)
0 0 vote
Article Rating
Subscribe
Notify of
guest
0 Comments
Inline Feedbacks
View all comments