Buerger's disease (Thromboangiitis obliterans): a diagnostic challenge.
Buerger's disease or Thromboangiitis obliterans is a segmental inflammatory disease that affects the vessels and nerves of the extremities. It usually affects men below 45 years old and correlates with tobacco, as a predisposing factor. The authors present the case of a 34-year-old male, with ulcers in the fingertips with progressive worsening: acrocyanosis, slow healing, necrosis and finally loss of substance. Dorsalis pedis and posterior tibial pulses were not palpable. Personal history of heavy smoking was (20 pack-years). The angiography revealed proximal occlusion of the left posterior tibial and interosseal arteries, with distal circulation by the anterior tibial artery. He was submitted to disarticulation of the second left toe and therapy with pentoxifyline and iloprost infusion, calcium antagonist, antiplatelet drugs, statin and low molecular weight heparin (later replaced by oral anticoagulation). Improvement was seen of active vascular lesions and pain symptoms.
Department 2, Curry Cabral's Hospital, Lisbon, Portugal. vandacristinajorge@gmail.com
Vanda Cristina
VC
Jorge
Ana Carolina
AC
Araújo
Carla
C
Noronha
António
A
Panarra
Nuno
N
Riso
Manuel
M
Vaz Riscado
D000328:Adult; D000792:Angiography; D001241:Aspirin / Q000627:therapeutic use; D000069059:Atorvastatin; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016285:Iloprost / Q000627:therapeutic use; D008297:Male; D009543:Nifedipine / Q000627:therapeutic use; D010431:Pentoxifylline / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D016540:Smoking Cessation; D013919:Thromboangiitis Obliterans / Q000175:diagnosis* / Q000188:drug therapy*
D002121:Calcium Channel Blockers; D006495:Heparin, Low-Molecular-Weight; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin; D009543:Nifedipine; D016285:Iloprost; D001241:Aspirin; D010431:Pentoxifylline