Buerger – s disease thromboangiitis obliterans causes symptoms and treatment

Currently, there are no effective treatments for Buerger’s disease. In the early stages of thromboangiitis obliterans, experts recommend conservative treatment associated with:

  • Elimination of the impact on the disease of etiological factors (in particular, smoking cessation);
  • Pain relief;
  • Elimination of vasospasm with ganglion blockers and antispasmodics;
  • Normalization of blood coagulation processes, improvement of its rheological properties;
  • Improving metabolic processes in tissues.

In the absence of a positive effect from conservative therapy, prerequisites for surgical intervention arise. In order to relieve spasm of peripheral arteries, surgeons perform lumbar sympathectomy. In the case of involvement of the upper limb vessels in the pathological process, a breast sympathectomy is performed.

The efficacy of an alternative clinical trial for Burger’s disease, stem cell injection, has not yet been formally confirmed.

The appearance of necrosis and gangrene on the affected limbs is an indication for amputation. According to statistics, approximately 35% of patients with this diagnosis cannot avoid surgical removal of the limbs.

The first step in treating Buerger’s disease is to completely quit the patient. According to statistics, 94% of patients who excluded nicotine from their lives immediately after diagnosis of the disease, avoided limb amputation.

At the same time, 43% of people with thromboangiitis obliterans who continued to smoke after being diagnosed suffered amputation of their legs or arms in the next 8 years. In general, the tactics of treatment depend on the severity of symptoms and the stage of the disease.

Conservative

Drug therapy is indicated for patients in the initial stages of the disease. The main agents that are prescribed for Buerger’s disease are vasodilator, antithrombotic, ganglioblocking and anti-allergic drugs.

In the presence of a secondary infection and ulcers, antibiotics are prescribed, non-steroidal anti-inflammatory drugs are prescribed to relieve ischemic symptoms, and immunomodulators are used as maintenance therapy.

The following drugs and procedures are commonly used:

  • Prednisolone to eliminate autoimmune inflammation.
  • Iloprost, vazaprostan for the expansion of small arteries, improve blood flow, fight blood clots.
  • Hemosorption and plasmapheresis for blood purification.
  • Perftoran and Oksiferol as “substitutes” for blood, because they are ways to transport oxygen.

All drugs should be prescribed only by a doctor! Self-medication is unacceptable.

Vascular surgery

Vascular surgery methods are used when conservative treatment does not give the desired effect. Usually, doctors resort to endarterioectomy (removal of the endothelium of the vessel on the clogged section of the artery), stening (installation of additional frame walls in the vessels), as well as prosthetics of the affected sections of the vessels.

With an unfavorable prognosis, the patient may be prescribed sympathectomy – a resection of the autonomic system, eliminating a spasm of peripheral arteries.

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Oxygen treatment in pressure chambers with high pressure is an experimental method in the fight against thromboangiitis obliterans. The data available to doctors are too scarce to fully talk about the effectiveness of hyperbaric oxygenation.

Amputation

Amputation is the last resort that doctors resort to in advanced cases: with severe chronic pain, gangrene, multiple ulcers. Typically, patients undergo low amputation (removal of the fingers, foot or part thereof), but with extensive development of the disease, the surgeon can remove part of the limb higher.

For the treatment of thromboangiitis obliterans, a complex technique is used, both surgical and therapeutic. This is necessary for one hundred percent gain in the effectiveness of the treatment of this disease.

Drug treatment includes the administration of angiospasmolytic drugs (compliance, nicospan, cinnarizine, vazaprostan); non-steroidal analgesics; agents that improve the rheological parameters of blood (trental, aspirin, chimes) and trophic tissue (B vitamins, actovegin, nicotinic acid, phosphaden, prodectin, dalargin).

Patients with thromboangiitis obliterans are prescribed training walking, photohemotherapy (UFOK, VLOK), plasmapheresis, hemosorption, hyperbaric oxygenation, and sanatorium treatment.

If conservative therapy is ineffective, the patient must consult a vascular surgeon. Surgical treatment of thromboangiitis obliterans may include:

  • lumbar sympathectomy;
  • bypass surgery of the affected vessels;
  • balloon angioplasty;
  • removal of nerves that are responsible in the body for vasoconstriction;
  • bone trepanation;
  • transplantation with vessels of the greater omentum;
  • with the development of gangrene – amputation of the affected limb.

Treatment of obliterating endarteritis of the vessels of the lower extremities (Buerger’s disease) is a very difficult task. This disease primarily affects the small vessels of the limbs, blocking blood circulation at the level of the arteries of the lower leg and foot. The pathological process consists in inflammation of the vascular wall, development within the connective tissue, which leads to a narrowing of the lumen and subsequent thrombosis.

Arterial circulatory failure leads to conditions that contribute to fatigue in the calf muscles, and then there is excruciating pain in the legs, feet and fingers, intermittent claudication, pain when walking. In the advanced stages, formidable symptoms of severe arterial insufficiency develop – trophic ulcers of the skin of the legs and ischemic gangrene of the fingers, constant excruciating pains. All this ultimately leads to amputation at the level of the lower leg or thigh.

Unhappy young people with obliterating endarteritis hope to receive treatment in the vascular departments, but desperate in the results, they turn to traditional medicine methods, while they do not find healing anywhere. Until now, Russian medicine considers obliterating endarteritis of the vessels of the lower extremities a disease, the prevention and treatment of which cannot be effective. But in the Innovative Vascular Center, they strongly disagree with this. We can treat obliterating endarteritis!

Surgeons of our center have been dealing with the problem of treatment of thromboangiitis obliterans (Vinivarter-Burger disease) since 2007. Attempts to apply standard approaches to vascular surgery are usually ineffective in this category of patients. The refusal of many vascular departments from surgical treatment leads to the fact that these patients often use folk remedies, and when the pain becomes unbearable, they agree to amputations.

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What medications are used to combat thromboangiitis obliterans? At the initial stage of the disease, specialists prescribe conservative treatment to patients. To prevent further progression of Burger’s disease and reduce the risk of limb amputation, a person is recommended to receive intravenous administration of Iloprost or its analogues.

To relieve pain, analgesics and non-steroidal anti-inflammatory drugs are prescribed. If there are ulcers, antibiotics are included in the treatment regimen. Drug therapy is carried out against the background of the patient’s complete cessation of smoking. If the patient cannot overcome his addiction, not a single medication will help him get rid of thromboangiitis obliterans.

Buerger’s disease is far from always curable with conservative therapy. If, against the background of the use of medications prescribed by a doctor, the ailment continues to progress, and necrotic processes develop in the tissues of the lower extremities, then the only way to treat it is surgery, in which the amputation of the affected limb is performed. Using this radical measure, surgeons try to save the patient most of the affected leg.

Thromboangiitis obliterans has a low mortality rate. For example, in the United States between 1999 and 2007. only 117 people died from this disease. The main condition necessary for a full recovery is a complete cessation of smoking. 94% of people who managed to overcome this bad habit were able to achieve good results in treatment and avoid amputation. Among those who continued to smoke, only 57% of patients could save the affected limbs.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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