The Management of Ischemic Limb in Thromboangiitis Obliterans (Buerger’s Disease)

Author(s):  
Ajay Kumar Khanna ◽  
Mohd Zeeshan Hakim
2021 ◽  
pp. 106-109
Author(s):  
Sanjeev Prakash ◽  
Keshri Amit ◽  
Nitin Chauhan ◽  
Khem Pal Singh

Introduction / Background: Buerger's disease is a systemic vasculitis of unknown etiology, strongly associated with tobacco abuse worldwide. Buerger described Thromboangiitis obliterans (TAO) in 1908. High prevalence is found in Asian / Middle East countries. The survival rate of TAO is almost 90%. Presently, total abstinence from tobacco is the mainstay of treatment. Aim: To determine the incidence, progression, etiology, impact of seasonal variations on admission, as well as, presentations, and treatment outcomes at our tertiary health care hospital in Uttarakhand region. Materials: Patients of Buerger's disease admitted to our Institute during January 2015 to December 2019, were included in this study. Methods: Retrospective analysis and study of 142 patients of Buerger's disease admitted at our institute. Results: Most patients were males (97%), with mean age 38.6 years. The incidence & total TAO admission were overall decreasing during these years. Trends showed that eighty two (58%) patients were admitted between months of November to February (cold weather), while least in summers (15%). More than 50% were severe smokers (>30 bidi / cigarette per day). Pain in limbs was present in 77.4% cases. Major amputations were done in (12) 8% cases, while digital / finger / forefoot amputations in 31.69% / 3.52% / 10.58.% cases respectively. Lumbar sympathectomy was done in twelve cases. The median requirement of analgesic (opioids) by intravenous & oral route was 10 & 12 doses initially, & mean VAS score on day-1, 5 & 10 was 6.4, 4.1 & 2.9 respectively. Conclusion: We conclude that incidence of TAO overall shows a decreasing trend, with better health practices. Admissions peak in the cold season, along with complaints related to painful / ulcerated limbs, with a strong association with tobacco abuse. Complete stopping of tobacco can halt further progression of TAO.


2010 ◽  
pp. 174-174
Author(s):  
AK Khanna ◽  
Puneet Puneet ◽  
Rahul Rahul

2020 ◽  
Vol 8 ◽  
pp. 205031212092763
Author(s):  
Mosaad Soliman ◽  
Khaled Mowafy ◽  
NA Elsaadany ◽  
Reem Soliman ◽  
Ahmed Elmetwally

Background: Thromboangiitis obliterans is an inflammatory disease affecting both medium- and small-sized vessels. Vasodilators, antiplatelets were proposed for treatment but the effect was minimal. Objective: This study was conducted to investigate the effect of balloon angioplasty on patients with Buerger’s disease compared to medical treatment. Methods: Between January 2006 and December 2016, 82 patients with Buerger’s disease were enrolled in the study, of whom 52 were randomized to the aggressive endovascular intervention and 30 were randomized medically by cilostazol and aspirin as a control group. In all, 23% of the patients presented with severe claudication, 50% with ischemic rest pain and 27% with ischemic ulcers. Randomization was done using the opaque envelope method. Allocation concealment was maintained to ensure no selection bias. Patient groups were compared for the duration of ulcer healing, ankle–brachial index, peak systolic velocity changes and transcutaneous oximetry (TcPO2) level for 30 months. Results: No major procedural complications occurred in the endovascular group. Angiographic success was achieved in 100% of supragenicular lesions but in 90% of infrapopliteal lesions. The endovascular group showed a statistically significant improvement in the ulcer healing size and duration at 6 months after the procedure with a mean time of 3 ± 0.9 months compared to 5.8 ± 1.69 months for the medical treatment group (p < 0.001), the mean TcPO2 from 27.23 ± 16.75 mm Hg (range: 0–56 mm Hg) before the procedure to 71.32 ± 12.94 mm Hg (range: 52–92 mm Hg) following revascularization (p < 0.01). The mean ankle–brachial index significantly improved from 0.54 ± 0.14 preoperatively to 0.82 ± 0.08 at final follow-up (p < 0.01). Conclusion: The endovascular therapy should be considered as an effective, safe, minimally invasive method in the light of the promising results after a modification of the standard technique.


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