MALADIE DE LEO BUERGER PDF

It usually affects men below 45 years old and correlates with tobacco, as a predisposing factor. The authors present the case of a year-old male, with ulcers in the fingertips with progressive worsening: acrocyanosis, slow healing, necrosis and finally loss of substance. Dorsalis pedis and posterior tibial pulses were not palpable. Personal history of heavy smoking was 20 pack-years. The angiography revealed proximal occlusion of the left posterior tibial and interosseal arteries, with distal circulation by the anterior tibial artery.

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It usually affects men below 45 years old and correlates with tobacco, as a predisposing factor. The authors present the case of a year-old male, with ulcers in the fingertips with progressive worsening: acrocyanosis, slow healing, necrosis and finally loss of substance. Dorsalis pedis and posterior tibial pulses were not palpable.

Personal history of heavy smoking was 20 pack-years. The angiography revealed proximal occlusion of the left posterior tibial and interosseal arteries, with distal circulation by the anterior tibial artery. He was submitted to disarticulation of the second left toe and therapy with pentoxifyline and iloprost infusion, calcium antagonist, antiplatelet drugs, statin and low molecular weight heparin later replaced by oral anticoagulation.

Improvement was seen of active vascular lesions and pain symptoms. The diagnosis and treatment of this entity is challenging, since it requires the exclusion of many other causes and a multidisciplinary approach.

An illustrative case-report and literature review is presented. A year-old black male presented in the medicine clinics with a 6 year history of ulcers in the fingertips of both hands and feet with progressive worsening: acrocyanosis, slow healing, necrosis and finally loss of substance. Sympaticectomy was unsuccessfully tried. A biopsy made in the past was consistent with local thrombophlebitis.

The patient had a known history of smoking 20 pack-year , controlled asthma, sinusitis and primary syphilis No other vascular risk factor was detected, namely diabetes, dyslipidemia or drug abuse. On clinical examination, the patient presented a cyanotic ulcerated lesion involving the two distal thirds of the second left toe figure 1.

The patient had an ulcerated lesion on the first right toe with purulent discharge. Dorsalis pedis and posterior tibial pulses were absent. Scar lesions with substance loss of the second and fourth right fingers and first left toe.

The study for thrombophilia and immunology was negative table 1. A possible source of systemic embolism was excluded by transthoracic echocardiogram and carotid-vertebral Doppler. The thoracoabdominopelvic CT was unremarkable. The nailfold capillaroscopy was suggestive of systemic vascular disease, with active capillaritis. The angiography abdominal, upper and lower limbs revealed proximal occlusion of the left posterior tibial and interosseal arteries, with distal circulation by the anterior tibial artery figure 4.

The angiography abdominal, upper and lower limbs revealed proximal occlusion of the left posterior tibial and interosseal arteries, with distal circulation by the anterior tibial artery. Disarticulation of the second left toe was performed along with medical therapy with pentoxifylline and iloprost infusion, calcium antagonist nifedipine , antiplatelet drug aspirin , statin atorvastatin , corticosteroid prednisolone , low molecular weight heparin later replaced by oral anticoagulation and analgesic therapy morphine, amitriptyline, gabapentin, paracetamol and ibuprofen.

The combination therapy: anticoagulation strategy, aspirin, prednisolone, pentoxifylline, nifedipine and atorvastatin revealed a long-term efficacy. Adherence to tobacco withdrawal was also crucial. The recent decline in the incidence of TAO has been more apparent than real and has most likely been related to initial over-diagnosis of the disease based on recognition of its status as a distinct entity , followed by underdiagnosis based on scepticism concerning its status.

One hundred years after the original description by Leo Buerger, the aetiology of the disease remains unknown. TAO is more common in males male-to-female ratio, ; its incidence is believed to be increasing among women, and this trend is postulated to be due to the increased prevalence of smoking among women. The hypothesis that infectious microorganisms as a contribute to the pathophysiology of the disease was also studied.

These cases might be triggered by cold, frostbite, traumatism of extremities or even abuse of sympathicomimetic drugs. The clinical criteria for TAO, edited by Olin in include: age under 45 years; current or recent history of tobacco use; presence of distal extremity ischemia, indicated by claudication, pain at rest, ischemic ulcers or gangrenes and documented by non-invasive vascular testing; exclusion of autoimmune diseases, hypercoagulable states and diabetes mellitus; exclusion of a proximal source of emboli by echocardiography or arteriography; consistent arteriographic findings in the clinically involved and non-involved limbs.

TAO may begin with joint manifestations such as recurrent episodes of arthritis of large joints, with transient, migratory single-joint episodes accompanied by local signs of inflammation. The wrists and knees are the most frequently involved joints. The arthritis is non-erosive. Joint problems precede the diagnosis of TAO by about 10 years on average. TAO usually begins with ischemia of the distal small arteries and veins. As the disease progresses, it may involve more proximal arteries.

Large arteries involvement is unusual and rarely occurs in the absence of small-vessel occlusive disease. There are case reports of cerebral, coronary, renal, mesenteric, pulmonary, iliac and aorta arteries involvement; even multiple-organ involvement may exist.

Biopsy and tissue sample are rarely required to establish the diagnosis. However, in a few cases with unusual location, the diagnosis should be established only when histopathological examination identifies the acute-phase lesion. Extensive arterial occlusion accompanied by the development of corkscrew collateral vessels is characteristic angiographic finding, but not pathognomonic. The disease is most often confined to the distal circulation and is almost always infra-popliteal in the lower extremities and distal to the brachial artery in the upper extremities.

Currently, there is no specific treatment for TAO. Smoking as few as 1 or 2 cigarettes daily, using chewing tobacco, or even using nicotine replacements may maintain the disease activity. Local hygiene, as well as the treatment of fungal and bacterial infection in the extremity, should not be ignored.

Similarly, there is no clinical evidence of benefits with the use of vasodilators, thrombolytic agents, anticoagulants and corticosteroids. Prostaglandins, in particular the intravenous iloprost, represents one of the more valid treatments in the TAO.

Recent studies have suggested that vascular damage caused by endothelin-1 may trigger peripheral arterial occlusive disease. The anti-inflammatory, antifibrotic and selective vasodilatory properties of bosentan endothelin-1 receptor antagonist have been shown to alleviate pain at rest and reduce the size of ischaemic ulcers caused by damage to the microcirculation.

Amputation of a limb or a segment of a limb must be postponed until after the patient has ceased smoking and gangrene has set in with clear demarcation.

There is no medical evidence that cervical or lumbar sympathectomy will improve survival or decrease the amputation rate; nevertheless, by improving collateral circulation and increasing superficial blood flow to the skin, such a procedure may help heal the ischemic ulceration and thus be beneficial in selected cases.

Bypass grafting has been successful in cases involving a femoro-popliteal segment. A promising new approach is on the edge with the use of gene transfer to induce therapeutic angiogenesis in TAO. The clinical course of TAO is characterised by acute exacerbations separated by phases of remission that may last several years.

Competing interests None. Patient consent Obtained. National Center for Biotechnology Information , U. BMJ Case Rep. Published online Sep Author information Copyright and License information Disclaimer. Correspondence to Dr Vanda Cristina Jorge, moc. This article has been cited by other articles in PMC. Case presentation A year-old black male presented in the medicine clinics with a 6 year history of ulcers in the fingertips of both hands and feet with progressive worsening: acrocyanosis, slow healing, necrosis and finally loss of substance.

Open in a separate window. Figure 1. Figure 2. Scar lesions with substance loss of the second and fourth right fingers. Figure 3. Table 1 Relevant laboratory parameters. Figure 4. Outcome and follow-up The combination therapy: anticoagulation strategy, aspirin, prednisolone, pentoxifylline, nifedipine and atorvastatin revealed a long-term efficacy. Footnotes Competing interests None. References 1. Olin JW. Ansari A.

Thromboangiitis obliterans: current perspectives and future directions. Hanly EJ. Buerger Disease Tromboangiitis Obliterans. Emedicine WebMD. Quintas A, Albuquerque R. Oral bacteria in the occluded arteries of patients with Buerger disease. Mayo Clinic staff. Olin JW, Shih A. Orphanet Encyclopedia WebMD.

Maladie de Buerger. Sang Thrombose vaisseaux ; 7 —5 [ Google Scholar ]. Treatment of Buerger disease Tromboangiitis Obliterans with bosentan: a case report. BMJ Case Reports Hirsch AT. Critical limb ischemia and stem cell research: anchoring hope with informed adverse event reporting.

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Thromboangiitis obliterans

It is strongly associated with use of tobacco products, [2] primarily from smoking , but is also associated with smokeless tobacco. There is a recurrent acute and chronic inflammation and thrombosis of arteries and veins of the hands and feet. The main symptom is pain in the affected areas, at rest and while walking claudication. Peripheral pulses are diminished or absent. There are color changes in the extremities. The colour may range from cyanotic blue to reddish blue.

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Maladie de Leo-Buerger faisant suite à une intoxication au cannabis

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Buerger’s disease (Thromboangiitis obliterans): a diagnostic challenge

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