BUERGERS DISEASE

By: Ns. Yulia

PRODI S1 KEPERAWATAN
STIKES KEPANJEN
2014
Thromboangitis Obliterans is a distinctive
disease that leads to vascular insufficiency,
characterised by segmental, thrombosing,
acute and chronic inflammation of medium
sized and small arteries and sometimes
secondarily extending into the veins and
nerves.

Leo Berger, 1879-1943,

Professor of Urology, NYPMS, NY, USA,
Described TAO in 1908
RISK FACTORS:
CIGARETTE SMOKING:
Most consistent aspect of this disorder.
Hypersensitivity to intradermally injected tobacco
extracts.
Increased prevalence of HLA-A9 and HLA-B5 in
these patients
Common in India, Japan & Israel pointing to its
genetic influences!.
SEX
MORPHOLOGY:
Sharply segmental acute and chronic vasculitis
of medium and small arteries.
MICROSCOPY:
Inflammation permeates the arterial walls.
Thrombosis of the lumen.
May undergo organisation or recanalisation.
Thrombus contains microabscesses.
Characteristic migratory recurrent superficial
phlebitis.
 CLINICAL FEATURES
The patient generally complains of pain while
walking at the arch of the foot.
Onset Age: 20 -40 yrs. Spontaneous and
gradual
Intermittent claudication, which progresses to
rest pain.
Swelling redness and slight pain
Postural dependency Trophic changes
Ulceration Gangrene.
DD: Raynauds disease, Senile gangrene
 PHYSICAL EXAMINATION
Local examination:
INSPECTION:
1. Change in color.
2. Signs of ischemia
3. Buergers postural test.
4. Capillary filling time
5. Venous refilling
PALPATION:
1.PALPATION OF BLOOD VESSELS.
2.CAPILLARY REFILLING.
3.VENOUS REFILLING.
4.ALLENS TEST.
5.COLD AND WARM WATER TEST.
6.NEUROLOGICAL EXAMINATION.
 INVESTIGATIONS
BLOOD
URINE
STRAIGHT X-RAY
ARTERIOGRAPHY:
I. RETROGRADE PERCUTANEOUS
CATHETERISATION.
II. DIRECT ARTERIAL PUNCTURE.
 DETERMINATION OF BLOOD VELOCITY BY
ULTRASOUND DOPPLER.
ISOTOPE TECHNIQUE
BLOOD LIPIDS.
INVESTIGATION FOR VASOSPASM
Browns vasomotor Index.
PLETHYSMOGRAPHY.
 MANAGEMENT
CESSATION OF SMOKING CAN ARREST THE
DISEASE.
MEDICAL
CILOSTAZOL
PENTOXIFYLLINE
SURGICAL
TRANSLUMINAL ANGIOPLASTY & STENTING(PTE,
PTFE).
BYPASS GRAFTS.