Treatment and prevention of Buerger's disease (Thromboangiitis obliterans)

Buerger's disease is a disease in which there is occlusion of small and medium arteries leading to ischemia of the part supplied by that artery which in turn cuases ischemic ulceration and gangrene. It is almost exclusively seen in smokers and men. There are many other risk factors too but smoking holds the key. Details about the disease and its risk factors are can be seen at Buerger's disease : A vascular disease in young smokers .

The diagnosis of Buerger's disease depends on its sign and symptoms, predisposing factors and there are some investigations to differentiate from ome other vasculitis and autoimmune diseases which can mimick Buerger's disease. The main symptoms include intermittent claudication, migratory thrombophlebitis and Raynaud,s phenomenon. Arteriography can detect the occlusion of the vessels. Complete details about sign, symptoms and diagnosis can be seen at Diagnosis of Buerger's disease.

Treatment of Buerger's disease is too difficult, but there are some medical as well as surgical treatment available to save the patient.

Medical treatment of Buerger's disease

Frankly speaking there is no treatment for Buerger's disease, thus an approach to reduce symptoms and minimize morbidity is the aim.

Abstinence from smoking

A complete abstinence from any form of tobacco either smoking or chewing should be maintained. Some person in order to quit smoking start using nicotine patch, even that is not allowed in a person with Buerger's disease. Quitting smoking may not reverse th disease but will certainly arrest its progression.

Thrombolytic therapy

Though thrombolytic therapy is not basically a treatment for Buerger's disease but due to occlusion of arteries, there may be turbulence in the blood flow leading to formation of thrombus which may obstruct important vessels like coronary artery and can be life threatening. In order to prevent that thrombolytic therapy is given in form of heparin in acute cases and aspirin as a preventive measure.

Prostaglandins

Recent development in the treatment of Buerger's disease is the use of prostaglandins. Intravenous iloprost has been used with some success in aressting the disease. Intravenous iloprost use is probably of greatest value in slowing progressive tissue loss and reducing the need for amputation in patients with critical limb ischemia during the period when they first discontinue cigarette smoking. Iloprost is an expensive drug and has been used selectively in USA.

Other medication required are antibiotic to prevent infection of the ulcer and analgesics to relief of pain. A very recently Isner and colleagues reported improved healing of ischemic ulcers and relief of rest pain in a small series of patients with Buerger disease using intramuscular gene transfer of vascular endothelial growth factor.

Surgical treatment of Buerger's disease

A mere reduction in smoking may not be sufficient to prevent the relentless progression of the disease. An established arterial occlusion often needs surgical interventions. A direct arterial surgery is not at all applicable, hence the surgical procedure required is -

Sympathectomy

Sympathetectomy of dissecting the sympathetic nerve supplying the occluded vesels may often result in healing of the ulcers and improvement in skin nutrition and relief of the pain.

Other surgical procedures may be required are omenatal transfer and Spinal cord stimulator implantation.

Amputation

In order to save the patient and to arrest progression sometimes a conservative amputation of the affected limb may be required.

Prevention of Buerger's disease

Whenever a discussion about Buerger's disease comes, abstinence for smoking is the first and prompt advice. Other preventive modes are to avoid exposure of cold which may prevent constriction of arteries and the ischemia may be less.

Cardiovascular exercises in form of running and aerobics should be encouraged.

Buerger's exercise is encouraged which include elevation and declination of limbs through waist which increases circulation.

Thus quit smoking and save your limbs is the basic fundamental of Buerger's disease. Preventive measures should be taken as early as possible to avoid disability nd morbidity.