The Management of Ischemic Limb in Thromboangiitis Obliterans (Buerger’s Disease)

The Role of Lumbar Sympathectomy in the Management of Buerger's Disease: A Systematic Review

“…The only established approach to prevent the progression of BD and avoid amputation is the complete cessation of tobacco usage. Nevertheless, even with such measures, the possibility of new episodes of ischemia and tissue loss cannot be discounted [15]. There have been reports suggesting a potential association between passive smoking and the presence of BD, although the evidence remains limited [15].…”

Thromboangiitis obliterans: a review

“…11 Additionally, in a study carried out by Tamai and collaborators to see the possible participation of NOTCH signaling in the pathogenesis of Buerger's disease, it was observed that certain genetic pathways that produce activation of JAG1 and Notch1 are very active in the endothelium of the vasa vasorum and the cells of the tunica media in patients with Buerger's disease and in some cases of aterosclerosis. 13 In 2022, a meta-analysis was carried out to assess whether plasma homocysteine concentrations had an effect on vascular damage, where they found that despite the scarcity of studies and other limitations in the study, the data are consistent in a participation of the plasma homocysteine in vascular damage, however, making it clear that it is unlikely to be genetically triggered. However, they point out that the increase in oxidative stress that accompanies Buerger's disease, whether mainly due to smoking or not, can inhibit cystathionine B-synthase, the first enzyme that catalyzes the transformation of homocysteine to cystathionine, so it can perpetuate and increase the homocysteine increasing oxidative stress and vascular damage; Therefore, they conclude that elevated homocysteine is more an effect of the inflammation that often accompanies Buerger's disease and is less likely to be a primary cause.…”

“…Now there are no costeffective and simple tests that guide the diagnosis, since biochemical alterations are usually non-specific, so the request for tests such as serum creatinine, blood glucose, CRP, ESR and certain antibodies such as ANCA and anticentromere have more value in ruling out differential diagnoses. 13 It has been described that patients with high anticardiolipin titers are mainly young and report a higher rate of amputations. 11 Malowski and collaborators in a group of 47 patients evaluated between 1990-1996 with Buerger's disease reported high titers of anticardiolipin antibodies and with the association that the greater their presence there could be a greater tendency to produce thrombosis and therefore more requirements for amputation.…”

“…The initial step is usually to exclude atherosclerosis or risk factors for other occlusive vasculopathies; The initial image is usually a Doppler ultrasound as it details the level of occlusion, luminal occlusion and quality of blood flow. 13 Subsequently, tomography or magnetic resonance arteriography can be considered, where lesions have classically been described as corkscrew-shaped collaterals defined as Martorell's sign which denotes changes in the vasa vasorum, presence of segmental lesions or can also be found in occlusions of the distal extremity. 5 For several years, several criteria have been proposed to suspect the disease, such as the Shionoya, Olin, Papa and Mills criteria, (Table 2).…”

“…Behcet. 13 Atherosclerosis obliterans is defined as a chronic arterial disease that produces symptoms of ischemia such as intermittent claudication, pain at rest, tissue loss secondary to obstruction of the arteries secondary to atherosclerosis, for which risk factors are often present. 29 Thus, the presence of risk factors or evidence of an atheroma usually excludes TAO.…”