Thrombangiitis Obliterans

Thrombangiitis Obliterans

Thrombangiitis obliterans or endangitis obliterans is a chronic inflammatory disease of the small and medium-sized blood vessels which, if left untreated, can lead to necrosis in the surrounding tissue structures of the affected extremity. In particular, men between the ages of 20 and 40 who consume a large amount of nicotine (98 percent) are affected by thromboangiitis obliterans.

What is Thrombangiitis obliterans?

Thrombangiitis obliterans (also endangiitis obliterans, Buerger’s syndrome, Morbus Winiwarter-Buerger ) is an inflammatory occlusive disease of the arterial and venous blood vessels, which has a chronic and relapsing course. For what does mds stand for, please visit ezhoushan.net.

As a rule, the smaller and middle distal blood vessels of the upper and lower extremities (foot, lower leg, hands, forearm) are affected segmentally by this form of vasculitis (inflammation of the blood vessels). As a result of the inflammatory processes, leukocytes (white blood cells) accumulate on the vessel walls, damage them and later cause thrombosis of the affected vessel, which leads to vascular occlusion and finally to necrosis of the adjacent tissue as a result of reduced blood flow ( ischemia ).

Thrombangiitis obliterans typically manifests itself in the form of ischemic claudication ( limping ), rest pain, paresthesia (sensory disturbances such as tingling, numbness, temperature perception disturbances), edema, cyanosis (blue discoloration of fingers and teeth) and ulcers (ulcers) or gangrenes (ischemic form of necrosis). In addition, thrombophlebitis (acute superficial phlebitis) and Raynaud’s syndrome (vasospasm) are characteristic side effects of thromboangiitis obliterans.

Causes

The exact etiology of thromboangiitis obliterans has not yet been fully elucidated. The disease is probably due to an underlying genetic predisposition autoimmune or allergic-hyperergic and is triggered in combination with certain noxae (exogenous toxins).

The antigens HLA-A9 and HLA-B5 are conspicuous in this respect, which in some studies could be increasingly detected in those affected. In particular, heavy nicotine consumption ( smoking ) is considered a trigger factor (initiating factor) for thromboangiitis obliterans, which can possibly be traced back to nicotine intolerance.

The high incidence among young men who are heavily dependent on nicotine is striking. Hyperhomocysteinemia is also discussed controversially as a potential triggering factor for the disease, although an association has so far only been proven in individual cases. In addition, in connection with thromboangiitis obliterans, research is still being carried out into whether the organism of smokers synthesizes autoantibodies against the body’s own collagen.

Symptoms, Ailments & Signs

The disease thromboangiitis obliterans only affects smokers. It usually begins before the age of 40. Women and men can suffer equally from the symptoms that occur in episodes. In a chronic form, symptoms stop on their own for longer periods of time. However, this in no way alleviates the causes.

You start again after a vacancy. Typical complaints are body aches. The hands are often affected. But the feet and calves can also hurt. It’s not just about the pain. Patients complain of a permanent feeling of cold. Bluish fingers and toes indicate this. Sometimes there are superficial skin ulcers. The nails often have necrosis. The death is favored by insufficient blood flow. Sometimes sufferers also describe emotional disturbances.

Thrombangiitis obliterans can have serious consequences. Entire limbs or parts thereof can die off. Individual fingers and toes or the entire hand are affected. Patients can then no longer work at a young age. The main complaints in the hands and feet are not exhaustive. Vascular inflammation can also spread to other organs. As a consequence, diseases of the heart, brain and gastrointestinal tract are possible.

Diagnosis & History

Thrombangiitis obliterans can often be diagnosed based on the characteristic clinical symptoms. Color-coded duplex sonography enables the flow rate of the blood and the adjacent tissue structures to be displayed.

Within the scope of a magnetic resonance angiography, vascular anomalies such as constrictions or occlusions can be detected, while a phlebography (X-ray of the veins using a contrast agent) can show obstructions to the flow (e.g. thrombosis ). Due to the increased risk of wound healing disorders in suspected thromboangiitis obliterans, a biopsy is only performed in unclear cases. The disease should always be differentiated from other vasculitis, arterial embolism, peripheral arterial occlusive disease and venous insufficiency in the differential diagnosis.

Thrombangiitis obliterans has a favorable prognosis in relation to life expectancy. With regard to the preservation of the affected extremities, the prognosis is considerably less favorable, especially in the absence of nicotine abstinence. About 40 percent of those affected by thromboangiitis obliterans later require amputation.

Complications

Thrombangiitis obliterans can have serious complications. Typical for the vascular disease are sensory disturbances and pain, which occur permanently if treatment is not given or is given too late. The typical blue discoloration of the skin, cyanosis, can develop into a so-called polycythemia in the case of a chronic course. This is followed by iron deficiency anemia and the resulting chronic exhaustion.

Cyanotic patients also have an increased tendency to bleed and often develop brain abscesses. Necrosis can lead to organ damage. In about 40 percent of cases, one or more extremities have to be amputated during the course of the chronic inflammatory disease. A possible sequela of thromboangiitis obliterans is Raynaud’s syndrome, which is associated with further pain, reddening of the skin and scleroderma. The therapy of the disease can be associated with side effects and interactions.

The typically prescribed analgesics cause gastrointestinal problems and skin irritations. Antirheumatic drugs, antibiotics and platelet aggregation inhibitors also harbor corresponding risks. Serious complications are only likely to occur with complex surgical procedures such as bypass surgery or amputation. Despite all the measures, there is always a risk that the thromboangiitis obliterans will recur elsewhere.

When should you go to the doctor?

The affected person is dependent on medical treatment for thromboangiitis obliterans. Further complications or complaints can only be prevented and limited by correct and, above all, early treatment, since this disease cannot heal itself. For this reason, a doctor should be consulted at the first signs and symptoms of the disease.

In the case of thromboangiitis obliterans, very severe pain in the limbs usually indicates the disease. The hands are particularly affected by this pain. However, there is also reduced blood flow, which can also lead to necrosis. Most patients also suffer from sensory disturbances, which can lead to limitations in everyday life. In some cases, thromboangiitis obliterans can also lead to inflammation of the internal organs.

Thrombangiitis obliterans can be recognized and treated by a general practitioner or an internist.

Treatment & Therapy

Strict abstinence from nicotine has absolute priority in the treatment of thromboangiitis obliterans, since this alone can halt the progression of the disease.

Although impairments that are already present are usually irreversible, in around 94 percent of cases additional amputations can be avoided later on by not smoking. Pain can be reduced with the help of analgesics or NSAIDs (non-steroidal anti- inflammatory drugs ). In the case of severe pain, temporary elimination of pain by epidural anesthesia can be an option.

In addition, the aim is to reduce the amputation rate by improving blood circulation in the affected extremities by relieving pressure (resting), thrombocyte aggregation inhibitors (including acetylsalicylic acid ) and intravenously infused prostaglandin derivatives (especially iloprost, alprostadil). The latter also reduce rest pain and significantly accelerate the healing of necrotic tissue. Necrotic structures and fibrin deposits should be removed and open wounds should be treated prophylactically against infection by regular rinsing.

If signs of infection are found, antibiotic therapy may be indicated. The long-term effect of a sympathectomy (surgical nerve blockade) has not yet been proven, although it may be an option due to its antispasmodic effect. In very rare cases, with pronounced ischemia, a bypass operation can be performed. In addition, people with thromboangiitis obliterans are advised to avoid exposure of fingers and toes to cold and heat baths.

Prevention

Since the exact cause of thromboangiitis obliterans is not clear, it cannot be prevented. Strict abstinence from smoking can, however, prevent the disease from manifesting itself or stop the progression of thromboangiitis obliterans.

Aftercare

As a rule, various follow-up measures are necessary in the case of thromboangiitis obliterans. These differ depending on the course of the disease and the chosen therapy. Stopping nicotine consumption immediately often leads to healing. However, in heavy smokers, the cessation process should be medically monitored.

It is therefore advisable to have regular check-ups with your family doctor or a specialist. The intervals between the follow-up examinations can vary greatly. There is often a strong craving for nicotine months and years after quitting smoking. In such cases, it is advisable for those affected to consult a family doctor.

Sometimes psychotherapeutic care is necessary. In advanced thromboangiitis obliterans, infusion therapy is often necessary. This usually requires an inpatient hospital stay, during which some follow-up examinations are already carried out. If there are no complications, at least one further check-up is usually necessary a few weeks later.

Ultrasound and X-rays of the affected area are usually taken. In a few cases, an amputation has to be performed in the case of thromboangiitis obliterans. The follow-up care is far more intensive and lengthy than in the case of a more favorable course of the disease. The healing of the surgical wound is initially closely monitored. A longer hospital stay is therefore required. This is followed by further measures to regain mobility.

You can do that yourself

There are a number of things sufferers can do themselves. However, a doctor should be consulted before use if possible.

Home remedies that can cool and reduce inflammation include alcohol wraps and apple cider vinegar. To do this, apple cider vinegar or alcohol from the pharmacy should be diluted with water. Cloths are soaked with it and wrapped around affected areas. This has a particularly cooling effect. Clay packs are also an old household remedy. Clay should be mixed with cold water to form a paste-like mixture and then applied to the affected areas as thick as a finger. This has an anti-inflammatory and decongestant effect.

The disease is associated with smaller blood clots. Accelerated blood circulation often helps to dissolve these. Movement and support stockings or a compression bandage in particular lead to the regression of blood clots. The heart rate increases with movement. The heart then pumps more blood and speeds up blood circulation. Support stockings and compression bandages press affected veins together and thus reduce the cross-section of the veins. The same amount of blood must then flow in the narrowed cross-section of the vein. This increases the flow rate. In addition, the function of the vein valves and thus the function of the vein pump are significantly improved by compression.

Nevertheless, a doctor should always be consulted, since in the worst case the disease can lead to a life-threatening pulmonary embolism.

Thrombangiitis Obliterans