(Winiwarter-Buerger’s disease)

The thromboangiitis obliterans is inflammatory thrombosis of small or medium-sized arteries and veins of some superficial, leading to arterial ischemia in the distal extremities and a superficial thrombophlebitis. Tobacco use is the main risk factor. The Symptoms include intermittent claudication, nonhealing foot ulcers, rest pain and gangrene. Diagnosis is based on clinical findings, noninvasive imaging, angiography and by the exclusion of other causes. The treatment consists in tobacco abstinence. The prognosis is excellent, is stopped when smoking; if not, the disease progresses inevitably continue and often requires amputation.

The thromboangiitis obliterans occurs almost exclusively in tobacco users to (almost all of them are smokers), affecting v. a. Men aged 20-40 years; they only rarely occurs in women. The disease manifests itself more common in people with HLA-A9 and HLA-B5 genotypes. The prevalence is highest in Asia and the Middle and Far East.

The thromboangiitis obliterans is inflammatory thrombosis of small or medium-sized arteries and veins of some superficial, leading to arterial ischemia in the distal extremities and a superficial thrombophlebitis. Tobacco use is the main risk factor. The Symptoms include intermittent claudication, nonhealing foot ulcers, rest pain and gangrene. Diagnosis is based on clinical findings, noninvasive imaging, angiography and by the exclusion of other causes. The treatment consists in tobacco abstinence. The prognosis is excellent, is stopped when smoking; if not, the disease progresses inevitably continue and often requires amputation. The thromboangiitis obliterans occurs almost exclusively in tobacco users to (almost all of them are smokers), affecting v. a. Men aged 20-40 years; they only rarely occurs in women. The disease manifests itself more common in people with HLA-A9 and HLA-B5 genotypes. The prevalence is highest in Asia and the Middle and Far East. The thromboangiitis obliterans leads to segmental inflammation in small and medium-sized arteries and, frequently, superficial veins in the extremities. In acute thromboangiitis obliterans Verschlussthromben accompany the Intimainfiltration with neutrophils and lymphocytes; Endotheloberfl√§chenzellen proliferate, but the internal elastic lamina remains intact. organize in an intermediate phase and the thrombus recanalization incomplete; the media is preserved but may be infiltrated with fibroblasts. In older lesions periarterial fibrosis can occur, which sometimes affects the adjacent vein and the adjacent nerve. The cause is unknown, although cigarette smoking is the primary risk factor. The mechanism may include a delayed hypersensitivity or toxic angiitis. According to another theory, the thromboangiitis obliterans may be an autoimmune disease, which is directed by a cell-mediated sensitivity to types I and III of the human collagen, which are components of the blood vessels. Symptoms and discomfort symptoms and complaints are those of arterial ischemia and of superficial thrombophlebitis. Some patients have a positive history for a wandering phlebitis, usually in the superficial veins of a foot or leg. The onset is gradual, starting in the distal vessels of the upper and lower extremities with cold feeling, numbness, tingling, or burning. These symptoms can develop over objective evidence of disease. Raynaud’s syndrome (Raynaud’s syndrome) is frequent. Intermittent claudication (rare usually in the arch of the foot or leg, hand, in the arm or thigh) occurs in the affected limb on to the rest pain and can proceed. Frequently, if the pain is severe and persistent, the affected leg feels cold to the touch, sweats excessively and cyanotic, probably due to over-activity of the sympathetic nervous system. Later, ischemic ulcers, which can progress to gangrene develop in most patients. The pulses are impaired or absent in one or more foot arteries and often at the wrist. Among young men who have smoking and ulcers on the limb, says a positive Allen test (the hand remains faded after the examiner the radial artery and the ulnar artery compressed simultaneously and then alternately releases) for the disease. In the affected hand, foot or fingers pallor occurs when lifting and redness when lowering. Ischemic ulceration and gangrene, usually of one or more fingers can occur early in the disease but not acutely. Noninvasive studies show a dramatic reduction in the blood flow and pressure in affected toes, feet and fingers. Diagnosis Other causes of ischemia are excluded by angiography examinations The medical history and physical examination suggest the diagnosis. It is confirmed when the ankle-brachial index (the systolic blood pressure ratio of ankle to arm) for the legs or segmental pressures for the arms show a distal ischemia when the echocardiography excludes cardiac emboli when blood tests (eg. B. Measurement of antinuclear antibodies, rheumatoid factor, complement, anti-centromere antibody, anti-SCL-70 antibodies) exclude vasculitis, if tests for antiphospholipid exclude Antiphopholipidantik√∂rpersyndrom (although these values ??can be obliterans slightly increased at a thrombangiitis) and when the angiography characteristic findings ( segmental closures of the distal arteries at the hands and feet, winding, corkscrew-like collateral vessels around the lesions around and no atherosclerosis) shows. Smoking cessation treatment Local measures Sometimes drug therapy The treatment consists in tobacco abstinence (tobacco use). A continuation of tobacco inevitably leads to disease progression and severe ischemia, which often requires amputation. Other measures include the avoidance of cold, of drugs that induce vasoconstriction, and thermal, chemical and mechanical damage, v. a. by ill-fitting shoes, a. In patients in the first phase of the tobacco abstinence iloprost 0.5-3 ng / kg / min i.v. can as an infusion over 6 hours help to avoid amputation. Pentoxifylline, calcium antagonists and thromboxane inhibitors can be used empirically, but this approach is not supported by data. Examines the use of antiendothelialen cell antibody measurements to track the progression of the disease. If these options are not effective, lumbar sympathetic chemical ablation or surgical sympathectomy can relieve ischemic pain and promote healing of ulcers in about 70% of patients with an ankle-brachial index ? 0.35 and without diabetes mellitus. Summary thromboangiitis obliterans is inflammatory thrombosis of small or medium-sized arteries and sometimes superficial venous in the distal upper and lower extremities. It occurs almost exclusively in male smokers aged 20-40 years. Claudication can occur and patients can develop ischemic ulceration and gangrene one or more fingers. The diagnosis is made clinically, but other causes of ischemia should be ruled out by tests. Smoking cessation is very important; iloprost infusion may help to prevent amputation, but there are only a few findings for the effectiveness of other substances before.

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