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| BACKGROUND | DIAGNOSIS | TREATMENT | SURGERY |
GLOSSARY OF TERMS
Buerger's Disease is named after Dr. Leo Buerger, who in 1908 at Mount Sinai Hospital in New York City gave the first pathological description of the disease. He originally called the condition: presenile spontaneous gangrene.
Thrombosis is the formation of a blood clot (thrombus) within a blood vessel that remains attached to its place of origin on the vessel wall.
An autoimmune reaction is one in which the patient’s immune system attacks the body’s own tissues.
Claudication is pain induced by insufficient blood flow during exercise.
Raynauld’s phenomenon is a condition manifests in which the distal extremities turn white upon exposure to cold.
Homocysteine is an amino acid found in the plasma of the blood, high levels are associated with vascular disease.
Erythrocytosis is a dramatic increase in the number of circulating red blood cells.
Thrombocytosis is an abnormal increase in the number of blood platelets.
BUERGER'S DISEASE
BACKGROUND
MECHANISM
Buerger’s Disease or Thromboangitis obliterans (TAO) as it is medically known, is characterized by inflammation (swelling) of the vessel wall of small to medium sized arteries and veins of the hands and feet in most cases, but can also affect the penis and scrotum.
This inflammation of the vessel wall causes a narrowing of the inner vessel space and diminished blood flow, resulting in thrombosis or complete vessel blockage. Without adequate blood flow beyond the inflamed vessel or thrombosis, the fingers, toes, and surrounding tissue begin the process of degeneration, leading to the appearance of sores, then ulcers, and ultimately gangrene.
CAUSE
Buerger’s Disease is associated with tobacco use, particularly cigarette smoking. Most patients with Buerger’s are heavy cigarette smokers. Some patients only smoke moderately, while other cases have been reported in users of smokeless tobacco. Although knowledge about the disease is limited due to its rare incidence, some medical scientists widely contend that Buerger’s is an autoimmune reaction triggered by some component of tobacco.
PATIENT PROFILE
The classic Buerger’s Disease patient has long been a young male between 20-40 years of age, who is a heavy smoker. Buerger's has historically been more common among men than women. More recently, however, a higher percentage of women and people over the age of 50 have been recognized to have the disease. It is more common in Israel, Japan and India along the ‘old silk route’ than in the United States and Europe. The disease is most common among South Asians but impacts other demographics as well.
SYMPTOMS
The initial symptoms of Buerger’s Disease often include enormous pain at rest or with exercise known as claudication in the feet and/or hands. The pain typically begins in the extremities, but may radiate to other parts of the body. Other signs and symptoms of the disease may include numbness and/or tingling in the limbs and the turning white of the fingers, hands, feet or toes upon exposure to cold (known as Raynauld's Phenomenon.
DIAGNOSIS
BLOOD ANALYSIS
Blood tests are performed to look at general health and to assess risk factors that affect the progression of the disease, including fasting blood cholesterol levels, blood sugar, kidney and liver function, and homocysteine levels.
DOPPLER/DUPLEX ULTRASOUND EXAMINATION
A measurement of blood flow and the identification of sites of vessel blockage is accomplished with the use of a hand-held Doppler probe. This allows the examiner to listen to the blood flow. The most accurate and detailed test, is a Duplex Ultrasound exam. This provides an ultrasound image of the vessel to determine whether there is any blockage or structural damage and is also able to record quality of blood flow as well as localised blood pressure.
TREATMENT
SMOKING CESSATION
Immediate and complete tobacco use cessation is absolutely essential. We require this not only of patients with Buerger’s Disease, but of all patients with circulatory disorders. Individuals who smoke not only put themselves at risk for developing vascular disease but also undermine attempts at treatment. Cigarette smoking in particular is known to cause erythrocytosis, plasma volume contraction, and thrombocytosis. These are all conditions which lead to dramatically increased risk of venous and arterial thrombosis. We understand the difficulty many smokers face in quitting and we work with our patients to overcome this personal challenge. We offer several strategic methods to help them end their addiction and improve their vascular health.
MOST TREATMENTS TODAY
The primary goals of most treatments of circulatory disorders today are to attempt to relieve symptoms and prevent further complications. At present, the majority of treatments act superficially in treating a patient’s symptoms and avoid dealing with the root of the problem.
Standard therapies typically include exercise programmes to try to increase blood supply to the affected tissues and the use of antibiotics to help in treating non-healing ulcers. Such therapies alone do not deal with the underlying cause of a patient’s illness. This is the reason the vast majority of treatments do not succeed.
ACHIEVING NEW HEIGHTS IN VASCULAR CARE
At Vascular General, we have developed innovative therapeutic procedures for the treatment of all circulatory disorders of the lower extremities that have consistently produced dramatically successfully results.
Due to the long duration and frequent reoccurrence of open sores or ulcers in the lower extremities, the microorganisms involved in the infection expand exponentially in number and develop into colonies that have a type of protective shield or layer of armor which is resistant to antibiotics. This is why all too often ulcers appear to be non-healing and do not respond to antibiotic medication.
The finding that low dose electric current can disrupt the protective layer shielding microbial colonies is well documented in the scientific literature. Our application of low dose electrotherapy in combination with antibiotic medication has time and again yielded the knockout punch to the life-threatening microbial colonies infecting chronic wounds.
SAVING LIFE AND LIMB
Within a few weeks of our treatments, persistent open wounds that never seem to close and were for so long a constant danger to life and limb, are cleaned from infection, closed, and allowed to heal. Our innovative use of low dose electrotherapy is not only a vital weapon in the battle against the spread of open wound infection but also a tool for the repair of such damages to the vascular system as inflammation of the vessel wall, ischemia, atherosclerosis, and thrombosis.
SURGERY
In more advanced stages of Buerger’s Disease, surgery may be recommended to bypass the blocked artery or vein or to clean out the area of blockage.
Minimally invasive procedures are performed with an endoscope (a small, flexible tube with a light, optical lens, and probe, forceps, suction device, or other instrument for surgery on the end), they include:
ARTERIAL STENT PLACEMENT: a procedure in which a wire-reinforced stent is placed in the artery and left in to keep it open
BALLOON ANGIOPLASTY: dilation of an obstructed artery by the passage of a balloon catheter through the vessel to the area of disease, inflation of the catheter balloon tip compresses the plaque against the vessel wall
ENDARTERECTOMY: surgical removal of the inner layer of an artery when thickened and obstructed
THROMBOLYSIS: catheter-assisted administration of highly concentrated anticoagulant medication to remove or break up a clot
BYPASS SURGERY: If the disease is very advanced, or if it occurs in an artery or vein that is difficult to reach with a catheter, bypass surgery may be necessary. A bypass graft may be performed in such serious cases. This surgical procedure uses either an artificial tube or one of the patients own arteries or veins to bring improved blood flow to the affected area.
