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BUERGERS DISEASE (THROMBOANGIITIS OBLITERANS)

Definition:

Buergers Disease (also known as: thromboangiitis obliterans; TAO; occlusive vascular

disease) is a rare disease characterized by recurring inflammation of the intermediate and smallarteries and veinsof the lower and upper extremities causing numbness and tingling and often

results to phlebitis and gangrene.

Etiology: Idiopathic/Immunopathogenesis

p Causative Factor: heavy smoking or tobacco chewingp RiskFactors:

Predisposing (non-modifiable)y Genetics (HLA antigen)y Diseases (hyoercoagulable state, Hepa B virus)y Gender (Male)y Age (between 20 and 35 years old)

Precipitating (modifiable)y Lifestyle (chain-smoking)y Occupation (outdoor and manual workers)

Signsand Symptoms

p Primary: Pain: intermittent claudication, relieved by rest Coldness

p Early: Intermittent claudication

p As occlusion progresses Pain: even at rest Increased sensitivity to cold Non-healing ulcers Diminished peripheral pulse

p Advance Change in the color of extremities Tissue gangrene

Complications:

Leg blood clots

Blocked leg arteries

Finger ulcers

Toe and/or foot gangrene

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DiagnosticProcedures

p Doppler Ultrasound: document patency of proximal vessels and visualize extent of distaldisease

p Contrast Angiography: identify diseased portion of anatomyNon-surgical Management

p Smoking cessationp Vasodilatorsp Proper foot care

Surgical Management

p Omental transferp Symphatectomyp Spinal cord stimulator implantationp Amputation: non-healing ulcer, gangrene and intractable pain.

Nursing Management

p Assist patient in developing and implementing plan to stop smokingp Encourage lifestyle changes if needed: diet modification, activity and hygiene (skin care).

Anatomy of the Vascular System

The vascular system consists of two interdependent systems: the right side of the heart

pumps to the lungs to the through the pulmonary circulation, and the left side of the heart pumps

blood to all the other body tissues through the systemic circulation. The blood vessels in bothsystems channel the blood from the heart to the tissues and back to the heart. Contraction ofventricles is the driving force that moves blood through the vascular system.

Arteries distribute oxygenated blood from the left side of the heart to the tissues, whereasveins carry deoxygenated blood from the tissues to the right side of the heart. Capillary vessels

located within the tissues connect arterial and venous systems. These vessels permit theexchange of nutrients and metabolic wastes between the circulatory system and the tissues.

Arterioles and venules, immediately adjacent to the capillaries, together with the capillaries,make up the microcirculation

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PATHOPHYSIOLOGY

Predisposing Factors:

-Genetics (HLA antigen)

-Diseases (hyoercoagulable state,Hepa B virus)-Gender (Male)

-Age (between 20 and 35 years old)

Precipitating

-Lifestyle (chain-smoking)

-Occupation (outdoor and manual

workers)

Constriction, occlusion and

inflammation of small arteries and

Buergers Disease

s/sx:pain, intermittent claudcation,sensitivity to

extreme temperatures, numbness, tingling, delayed

wound healing, and diminished peripheral pulse

Decreased blood

supply to upper and

lower extremities

Smoking is ceased

Cessation of signs and

symptoms and timely

wound healing

Smoking is continued

Complications:Leg blood clotsBlocked legarteriesFinger ulcersToe and/or foot

gangrene