Thromboangiitis obliterans

The thromboangiitis obliterans or thromboangiitis obliterans is a segmental vessel inflammation ( vasculitis) smaller and medium-sized arteries and veins predominantly of the lower extremity. Internal organs are not usually affected. Synonyms are Thrombangiitis obliterans Buerger or Winiwarter - Buerger's disease, named after Felix of Winiwarter and Leo Buerger.

Affected are usually young men under 40 years with a strong nicotine consumption (75 % of those affected ). In Western Europe, with the exception of the Mediterranean rather rare, most prevalence in India, Korea and Japan. Life expectancy is usually not reduced.

Etiology

The cause of thromboangiitis obliterans is unknown, but is postulated an interaction of genes (especially HLA B5 and A9) and exogenous pollutants ( Noxen ) ( nicotine). Also autoantibodies are discussed in the making. The nicotine leads to excessive toning the veins and thus wins the (blood) flow as a pathological factor in importance. There seems to be a genuine production of inflammation.

Symptoms and diagnosis

Most falls on a cold sensation of the affected extremity in combination with rest pain, similar to those of peripheral arterial occlusive disease. It is also typical Raynaud's syndrome of the affected limb as well as a migratory superficial inflammation of the veins ( thrombophlebitis / phlebitis ). A bluish discoloration of the outer extremities accompanied by tenderness can also be a sign of disease. Found on the fingers and toes partly necrosis, gangrene and trophic disorders of the nails. The diagnosis is usually based on the clinical course, angiographic and patho - histological examination of the affected vessels.

Differential Diagnosis

Especially the classic peripheral arterial occlusive disease, arterial embolism, venous insufficiency and other vasculitides must be excluded.

Pathology

Initial there is a mixed inflammatory infiltrate of lymphocytes, granulocytes and plasma cells in all vessel wall layers. The inflammation leads to endothelial damage with secondary Auflagerung of thrombotic material and necrosis of the tunica media of the vessels and ultimately to the closure of the affected vessel. The thrombus may be recanalized in the further course. The vessel wall fibrotic most.

Therapy

Instant nicotine waiver may result in stoppage of the disease. Patients who continue to smoke, have a poor prognosis. Infusion therapy with prostaglandin E1 and prophylactic therapy with aspirin is recommended. Maybe can help a sympathectomy. With extensive necrosis amputation may be necessary. The amputation rate of the affected limb is approximately 30 percent.

First description

• F. v. Winiwarter: About a peculiar form of endarteritis and endophlebitis with gangrene of the foot. IN: Arch Klin Chir 23/1879 page 202