Thromboangiitis obliterans ( Buerger’s disease)

Thromboangiitis obliterans ( Buerger’s disease) is a recurring progressive inflammation and thrombosis of small and medium arteries and veins of the hands and feet. It is strongly associated with use of tobacco products, primarily from smoking, but also from smokeless tobacco. There is a recurrent acute and chronic inflammation and thrombosis of arteries and veins of the hands and feet. The main symptom is pain in the affected areas. Ulcerations and gangrene in the extremities are common complications, often resulting in the need for amputation of the involved extremity.

This disease was first reported by Leo Buerger in 1908, who described a disease in which the characteristic pathologic findings — acute inflammation and thrombosis (clotting) of arteries and veins — affected the hands and feet. Patient often complains that he feels pain while walking a short distance and pain relives on rest and he can walk again for short distance. If we enquire further he will say his foot drops after short walk (claudication)

1. Typically between 20–40 years old and male, although recently females have been diagnosed.
2. Current (or recent) history of tobacco use.
3. Presence of distal extremity ischemia (indicated by claudication, pain at rest, ischemic ulcers or gangrene) documented by noninvasive vascular testing such as ultrasound.
4. Exclusion of other autoimmune diseases, hypercoagulable states, and diabetes mellitus by laboratory tests.
5. Exclusion of a proximal source of emboli by echocardiography and arteriography.
6. Consistent arteriographic findings in the clinically involved and noninvolved limbs.

Buerger’s disease can be mimicked by a wide variety of other diseases that cause diminished blood flow to the extremities. These other disorders must be ruled out with an aggressive evaluation, because their treatments differ substantially from that of Buerger’s disease.

One day a male patient came to dr.e.r.sivanandam,tamil siddhar nilayam, with complaints of pain in his leg while walking 100 M for period 3-6 months. His profession is weaver and he is hsbitual smoker who smokes for around 20 years.he was taken dopler of both his lower limbs and diagnosed TAO. Surgens recommended amputation of his toe but he was not willing because he needed it for his profession. So he gave medicines which was given by dr.e.r.ramasamy for similar complaints. He got improved by 10% in his first week of treatment and was able to walk around 1 km. by the end of 4 th week he was able to walk few kms without any rest. He was taken Doppler again and saw that the stenosis was reduced by 50% and bloodflow was fine. He went home happily and the medicines were effective not only for TAO but also for other similar problem. We had discussion and finally decided to take this medicine for research in CAD and other vascular diseases which are all similar in its cause.this research work is in primilary stage and hope to have a big break soon.