1/29. Vascular reconstruction in Buerger's disease.In 23 of 148 patients with Buerger's disease, it was possible to undertake 27 arterial reconstructive procedures: bypass in 22 and thrombo-endarterectomy in 5. In a follow-up of 10 months to 8 years, the overall patency rate was 26 per cent. The long term patency rate of bypass grafting was good in obstruction of main vessels, but unsatisfactory with multiple occlusions. Bypass grafting was preferred to thromboendarterectomy. To obtain long term patency of revascularaized segments, complete abstinence from tobacco is absolutely essential. The preparatory manoeuvres for antogenous venous graft should be as atraumatic as possible. A functional diagnosis is indispensable when considering operative indications and for follow-up study of patients with peripheral arterial occlusive disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/29. Implantable spinal cord stimulator to treat the ischemic manifestations of thromboangiitis obliterans (Buerger's disease).thromboangiitis obliterans (Buerger's disease) is a segmental inflammatory vasculitis that involves the small-sized and medium-sized arteries, veins, and nerves. It is causally related to tobacco use. The diagnosis is usually made on the basis of the presence of distal arterial disease in individuals who smoke and in whom other disease entities have been excluded. The most effective treatment for Buerger's disease is smoking cessation. Without strict adherence to tobacco avoidance, disease progression is likely. methods to control ischemic pain include medications, sympathectomy, or surgical revascularization. The effect of sympathectomy is unpredictable, and the chances of a successful revascularization procedure are rare because distal target vessels often are extensively diseased. Herein, we describe a patient whose condition did not respond to the usual conservative therapy but did respond dramatically to the implantation of a permanent spinal cord stimulator. Although these devices have been used for more than 20 years in various other peripheral arterial diseases, their use in Buerger's disease has been limited.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/29. Cerebral vein thrombosis in a case with thromboangiitis obliterans.thromboangiitis obliterans is a chronic inflammatory vessel disease that involves predominantly the small and medium-sized arteries and veins of the distal extremities. Appearance and cessation of symptoms are closely related to patterns of tobacco consumption. That cerebral arteries can also be involved is shown by reports of rare cases in which cerebral artery occlusion led to infarction. We report on a 28-year-old man with thromboangiitis obliterans who developed extensive cerebral vein thrombosis after a single episode of cigarette smoking following several years of nonsmoking. Despite extensive evaluation, no other known cause or predisposition of cerebral vein thrombosis could be found. This case suggests that cerebral veins can be involved in thromboangiitis obliterans and patients with thromboangiitis obliterans might be at risk for cerebral vein thrombosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/29. thromboangiitis obliterans: a rare cause of a reversible Raynaud's phenomenon.A 25-year-old woman with progressive Raynaud's phenomenon and digital necrosis is presented. Systemic sclerosis and other connective tissue disorders as well as atherosclerosis and arterial emboli were excluded with appropriate laboratory examinations. Arteriography revealed multiple palmar and digital occlusions with corkscrew-shaped vessels. Based on these characteristic arteriographic and clinical findings, the diagnosis of thromboangiitis obliterans was finally retained. With intravenous perfusion of the prostacyclin analogue iloprost (2 ng/kg/min, 6 h daily during 21 days), a complete healing of Raynaud's phenomenon and of the digital necrosis was observed. There was no recurrence during the 1-year follow-up. This observation demonstrates that thromboangiitis obliterans is a potential reversible cause of severe Raynaud's phenomenon in young women even in the absence of lower limb involvement. Early recognition is important to avoid irreversible complications such as loss of digits.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/29. Intestinal involvement in Buerger's disease.thromboangiitis obliterans characteristically affects small- and medium-sized vessels of the limbs in young smokers. There is some controversy about the existence of visceral localizations of the disease. The case of a patient with a well-established diagnosis of thromboangiitis obliterans who presented with mesenteric ischemia is described and the literature concerning mesenteric involvement in the disease is reviewed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/29. Buerger's disease affecting mesenteric arteries: a rare cause of intestinal ischemia--a case report.Buerger's disease is a recurrent, inflammatory, segmental, vasoocclusive disease. Typically, the disease affects middle-aged male smokers and involves arteries and veins of extremities. Buerger's disease involving visceral vessels is rare. The authors report on a 51-year-old man with peripheral arterial disease and recurrent intestinal ischemia secondary to Buerger's disease. Clinical and histopathologic features of this case illustrate the life-threatening nature of visceral involvement in Buerger's disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/29. Beyond peripheral arteries in Buerger's disease: angiographic considerations in thromboangiitis obliterans.thromboangiitis obliterans is an inflammatory peripheral vascular disease that is strongly associated with smoking. It predominantly affects distal small- and medium-sized blood vessels of both the upper and lower extremities. We present histological evidence of this disease process affecting the internal mammary arteries. This can be of paramount clinical significance for patients with Buerger's disease who present with obstructive coronary artery disease and require coronary artery bypass grafting surgery (CABG). Internal mammary arteries involved with thromboangiitis obliterans cannot be utilized as arterial conduits during CABG and other alternatives have to be used. Therefore, we recommend preoperative angiography of both internal mammary arteries in patients with Buerger's disease requiring CABG to prevent extensive intraoperative dissection of diseased internal mammary arteries.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/29. thromboangiitis obliterans (Buerger disease) in a female mild smoker treated with spinal cord stimulation.The authors report the case of a 42-year-old female mild smoker admitted to the Hospital of Ferrara for the onset of asymptomatic necrotic ulcerations localized to the second, third, and fourth toes of left foot. physical examination showed asphygmia of inferior limb distal peripheral pulses, with localized extremity marbleized and cyanotic skin at the level of the left foot, where necrotic ulcers were present at the second, third, and fourth toes. Doppler ultrasonography and angiography revealed a severe obliterating arteriopathy of bilateral distal arterial circulation. Both blood chemistry panel (including autoimmune and hypercoagulable profile) and diagnostic examination findings were normal. Thus, the patient met several criteria to be diagnosed with Buerger disease. After an attempt at medical therapy with the intravenous administration of the prostaglandin-analogue iloprost, given the young age and the lack of viable distal target vessels for bypass grafting, a spinal cord stimulator was implanted. More than 2 years later, the patient has a normal life.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/29. cannabis arteritis.The main causes of arteriopathy in young patients include drugs, metabolic diseases, pseudoxanthoma elasticum and Buerger's disease. arteritis due to cannabis indica was first reported in 1960, and the role of this drug as a risk factor for arteritis was confirmed in several subsequent publications. A 38-year-old smoker with no previous contributory medical history except for long-standing cannabis abuse developed a dry necrotic lesion of the left big toe. Imaging examinations revealed proximal arteriopathy of the lower limbs that predominated on the left side. He had no atherogenic or thrombogenic risk factors, and no signs of pseudoxanthoma elasticum were found. Remarkably, the development of arteritis paralleled cannabis abuse. The course was slowly favourable after weaning from the drug, vasodilator treatment and hyperbaric oxygen therapy. Despite some subtle clinical differences (more proximal than distal involvement), cannabis arteritis may be considered as a particular form of Buerger's disease, where cannabis, along with tobacco, seems to cause arterial lesions. Along with the noxious effects of cannabis on vessels, a role for contaminating arsenic is also possible. cannabis arteritis is not widely known, but may prove not to be so rare if one considers consumption of cannabis besides that of tobacco.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/29. Mesenteric involvement of acute-stage Buerger's disease as the initial clinical manifestation: report of a case.Buerger's disease is almost always a disease of the blood vessels in the extremities. Conversely, mesenteric involvement of Buerger's disease is rare, and no true series have been reported. We report the case of a 37-year-old man with clinical symptoms of upper extremity Buerger's disease, who underwent surgery for extensive small bowel infarction. Histopathologic findings revealed that the mesenteric arteries were swollen and infiltrated with neutrophils, but not associated with fibrinoid necrosis. The lumen was occluded by a highly cellular thrombus with the appearance of a microabscess. These findings were compatible with acute-stage mesenteric Buerger's disease and postoperative studies revealed multiple occluded segments in the small and medium-sized arteries of both legs and the left arm, suggestive of Buerger's disease in the extremities.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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