non-atherosclerotic diesease diagnosied by - male + smoker +
THROMBOANGIITIS OBLITERANS
SYN. BUERGER’S DISEASE
- exclusively seen in males of young age group with history of smoking.
- Almost always starts in lower limb, may start on one side and later on the other side. Only upper limb involvement can occur (not uncommon) but it is rare.
- segmental, progressive, nonatherosclerotic inflammatory occlusive, disease of small and medium sized vessels with superficial thrombophlebitis often may present with microabscesses, along with neutrophil and giant cell infiltration, with skip lesions.
- Intermittent claudication in foot and calf progressing to rest pain, ulceration, gangrene.
- Recurrent migratory superficial thrombophlebitis.
- Absence/feeble pulses distal to proximal; dorsalis pedis, posterior tibial, popliteal, femoral arteries.
- May present as Raynaud’s phenomenon.
PATHOGENESIS
Smoking Causes vasospasm and hyperplasia of intima ↓ Thrombosis and obliteration of vessels occur, commonly medium sized vessels are involved ↓ Panarteritis is common. Usually involvement is segmental Eventually artery, vein and nerve are together involved ↓ Nerve involvement causes rest pain Patient presents with features of ischaemia in the limb ↓ If patient continues to smoke, disease progresses into the collaterals, blocking them eventually, leading to severe ischaemia and is called as decompensatory peripheral vascular disease.
critical limb ischaemia. - It causes rest pain, ulceration, gangrene
Shianoya’s criteria for Buerger’s disease
- Tobacco use.
- Only in males
- Disease starts before 45 years
- Distal extremity involved first without embolic or atherosclerotic features
- Absence of diabetes mellitus or hyperlipidaemia
- With or without thrombophlebitis