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Buerger's Disease

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Buerger’s disease is an inflammatory disorder affecting small and medium sized arteries with unknown etiology and strong association with smoking. It is a difficult disease to treat and abstinence from smoking is must to arrest the progress. Conservative treatments like vasodilators, anti- coagulants, prostaglandin therapy etc. have questionable role. Arterial reconstructive surgery is not feasible usually. Sympathectomy, though widely used works partially or not at all. Progression of the disease invariably leads to amputation. Over the years, the methods and devices have evolved and its indications have been extended to treat fractures and associated complications: nonunion, chronic osteomyelitis, shortened extremity, joint contracture, and…show more content…
Use or exposure to tobacco plays central role in the initiation and progression of the disease. Similarly to other autoimmune diseases, Burgers disease may have a genetic preference without a direct "causative" gene mutation. Most investigators feel that Buerger's disease is an immune-mediated endarteritis. Recent immunocytochemical studies have demonstrated a linear deposition of immunoglobulins and complement factors along the elastic lamina. The inciting antigen has not been discovered. The role of hyperhomocysteinemia in the pathogenesis of Buerger's disease is controversial. An association between thrombophilic conditions such as antiphospholipid syndrome and Buerger's disease has also been suggested .Peripheral endothelium-dependent vasodilation is impaired in patients with Buerger's disease, while non-endothelial mechanisms of vasodilation seem to be…show more content…
For clinical diagnosis, every patient should have evidence of all of the major criteria and at least one of the minor criteria. The major criteria should include: Age of Buerger’s disease onset of less than 50 years; this might be sooner than the age of reporting to a health-care provider. Some patients experience cold sensitivity or thrombophlebitis migrans some years before the onset of ischemia ;( The patient should be from a low socioeconomic class or from a stressful situation or should be an immigrant from a country with social, economic or political crises; Small- and medium-sized arteries of the lower limb are involved; involvement of large vessels should be due to hypercoagulable states or atherosclerotic changes.1,6 Buerger’s disease case reports with involvement of large vessels have not yet confirmed the diagnosis of Buerger’s disease; Dependence of symptoms, in particular burning pain following tobacco usage instead of ‘history of cigarette smoking’. Smoking affects the outcome of many vascular diseases; however, in Buerger’s disease, the patient’s symptoms, in particular the burning pain and TM, have a close relationship with tobacco consumption, even with chewing tobacco. (Bahare Fazeli
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