Smoking is a pernicious habit that can cause a number of diseases, among which the Vinivarter-Burger disease, or obliterating thromboangiitis, is not the last place.
This is a serious pathology of the arteries of the hands and feet, which as a result can lead to their amputation and subsequent disability of the patient.
General Information
Burger's disease is an narrowing of the small and medium veins and arteries in the regionand upper and lower extremities ( sometimes manifested in the cerebral pathology, coronary and visceral arteries).For the first time this disease was described in 1908 by the German physician Leo Burger, who claimed that it was the reason for his 11 operations to amputate limbs.
Causes and Risk Factors of
Despite numerous studies, the exact etiology of Burger syndrome is not fully understood by .The disease affects mainly smokers, but the fact that it occurs in a certain number of people, speaks of their susceptibility to obliterating thrombangiitis.
There are assumptions about the presence in the body of patients of antigens A9 and HLA-B5 and antibodies against elastin, laminin and collagen of the 1st, 3rd and 4th types of .
It is also associated with the following factors:
- acute respiratory infections and intoxication of the body;
- is a neuro-allergic reaction that contributes to an increase in vascular sensitivity to adverse effects;
- hypothermia of the extremities;
- hereditary predisposition to circulatory disorders.
Classification and stages of
The distinguishes between two forms of Burger disease: peripheral and mixed .In the first case, the pathology affects the vessels and main arteries of the extremities and has a characteristic symptomatology of arterial ischemia of the lower extremities, acrocyanosis, migrating thrombophlebitis. In patients with a mixed form, not only leg lesions are noted, but also changes in the vessels of the brain, heart, kidneys and lungs.
The development of obliterative thrombangiitis includes four stages:
- At the first stage of the , the legs of a person quickly get tired, the tingling of the is felt in the fingertips, which gradually becomes a burning sensation. Fingers are always cold, and in calves and feet severe pain begins even after a short walk.
- The second stage is characterized by lameness after a short pedestrian crossing .In the arteries, the pulse ceases to be felt( a similar symptom is in Takayasu's syndrome), and visual changes appear on the legs: hair growth slowing, weight loss, thickening of the nails, coarsening of the skin of the feet.
- After the disease passes to the third stage, pains begin to disturb a person not only during walking, but also at rest .Begins swelling and atrophy of the muscles of the legs, and any scratch or damage to the skin develops into an ulcer.
- In the fourth stage of , limb tissues begin to die - if the patient does not seek medical help, extensive ulcers and gangrenous changes appear on his legs.
These photos show the neglected state of Burger's disease:
The started stage of Buerger's disease.
Start of putrefaction due to thrombangiitis obliterans.
Extensive ulcers and gangrene of the legs as a consequence of untreated Buerger syndrome.
Danger and complications
Death as a result of Buerger's disease occurs quite infrequently - for 8 years in the US, 117 deaths have been recorded. However, leads to serious complications, including venous and arterial acute thrombosis, as well as gangrene .
Symptoms and when to consult a doctor
Symptoms that a doctor can diagnose with a 100% chance of a thromboangiitis obliterans do not exist, but some indirect signs are still capable of indicating the development of the disease.
In the first stages of the , patients feel a tingle or "creep" in the fingers and toes of the , the limbs become cold to the touch and sweat strongly. During walking patients suffer pain and cramps, mainly in the area of the feet and shins.
As the develops, a slight lameness appears, the affected area acquires a bluish shade of , and on the skin appear jaundices that increase in size and develop into gangrene.
Since at the risk of Buerger's disease smokers are primarily in the first place, all people who have this habit need to be careful about the health of their feet .
Any discomfort when walking without an obvious cause, which does not disappear for a long time, can talk about the development of the disease. In such cases, the patient is recommended to visit the therapist , who will listen to the patient's complaints and give directions for additional studies.
Diagnostics
Diagnosis of obliterative thromboangiitis is performed by excluding other diseases( differential diagnosis) with similar symptoms. For this, the patient needs to undergo the following tests and studies:
- Blood and urine tests : general, analysis for hepatic enzymes, glucose level, C-reactive protein, antinuclear antibodies, rheumatoid factor.
- Functional tests of ( revealing the symptom of the plantar ischemia of Oppel, Goldflam's test, Panchenko's knee phenomenon).
- Doppler ultrasound is a study that determines changes in microcirculation in the small arteries of the upper and lower extremities.
- Angiography is a method of contrast study of vessels with the help of an X-ray apparatus that identifies segmental lesions of the arteries.
- Ultrasonic angioscanning of , with the help of which the vessels of the legs and hands are examined for their lesions and circulatory difficulties.
In addition, the patient is assigned other tests and studies of designed to exclude the presence of sources of embolism( including the risk of pulmonary thromboembolism), obliterating atherosclerosis( about him here) and autoimmune diseases.
Methods of treatment
The first step in the treatment of Burger's disease is the complete refusal of the patient from smoking. According to statistics, , 94% of patients who excluded nicotine from their lives immediately after diagnosing the disease, avoided amputation of the extremities of .
At the same time, 43% of people with obliterating thromboangiitis, who continued to smoke after diagnosis, underwent amputation of legs or hands in the next 8 years. In general, the tactics of treatment depend on the severity of the symptoms and the stage of the disease.
Conservative treatment
Drug therapy is indicated to patients in the initial stages of the disease. The main drugs that are prescribed for Buerger's disease are vasodilators, antithrombotic, ganglion blocking and antiallergic drugs.
In the presence of secondary infection and ulcers antibiotics are appointed, non-steroidal anti-inflammatory drugs are used to alleviate ischemic symptoms, and immunomodulators serve as maintenance therapy.
Vascular Surgery
Methods of vascular surgery are applied when conservative treatment does not give the desired effect. Usually, doctors resort to the endarterialectomy ( vascular endothelium removal at the occluded artery site), stenosis ( installation of additional frame walls in the vessels), and prosthetics of the affected vascular departments.
Hyperbaric oxygenation
Oxygen treatment in pressure chambers with increased pressure is an experimental method in the control of obliterative thromboangiitis. The data available to doctors is too scarce to fully talk about the effectiveness of hyperbaric oxygenation.
Amputation
Amputation - is an extreme remedy to which doctors resort in advanced cases of : with severe chronic pain, gangrene, multiple ulcers. Usually patients undergo low amputation( removal of fingers, feet or parts thereof), but with extensive development of the disease, the surgeon can remove part of the limb above.
Recommendations
People with a diagnosis of Burger's disease need to protect limbs from any negative effects of : colds, chemicals, fungal infections and mechanical damage.
To improve blood circulation, is recommended daily for patients with daily short walking time ( 15-30 minutes);The exception is patients who have severe pain, extensive ulcers or gangrene - they need bed rest.
Read more about the disease from this video:
Prevention
The main preventative measures are the healthy lifestyle and the rejection of nicotine , which reduces the risk of developing obliterative thromboangiitis to a minimum.
All factors that could affect the microcirculation in the vessels should be completely eliminated: uncomfortable shoes, prolonged standing on the legs, hypothermia of the extremities. An important element of prevention is daily walks, proper nutrition and exercise in strengthening sports.
Obliterating thromboangiitis of the upper or lower extremities - is a dangerous disease, which, however, is not a sentence to the health and life of the patient .With timely diagnosis, a responsible attitude to your health and the prevention of complications, the patient has a chance of a full recovery.
