Thrombangiitis obliterans

The Thrombangiitis obliterans represents an obliterating thromboangitis - narrowing of veins and arteries of the average and small sizes in upper and lower extremities as a result of inflammatory process. In rare instances pathology is shown in coronary, cerebral and visceral arteries.

The disease was described by the German doctor Leo Byurger in 1908 who stated a hypothesis that this disease became the reason of 11 amputations of extremities which are carried out by him.

Traditionally it is considered that Thrombangiitis obliterans are subject, the men generally smoking aged from 20-40 years. However cases of diagnosing of a disease at women became frequent in recent years that has a talk with distribution of smoking among women.

Despite assumptions of specialists, the disease etiology is up to the end not found out: there are instructions concerning influence on an organism of patients of hereditary factors, in particular, of a carriage of HLA antigens - B5 and A9, and also existence for the sick antibodies directed against laminin, elastin and collagen I, III and IV of types.

Clinical picture of a Thrombangiitis obliterans

Pathomorphologically gradual decrease in blood circulation of hands or legs is observed, since distal departments (finger-tips) and extending proksimalno (up). Inflammations of arteries are characterized by cellular and infiltrative processes in all three layers of a vascular wall: defeat of an intima, splitting of cellular membranes, a hyperplasia of an endothelium and the expressed thrombosis.

Distinguish two main forms of defeat: peripheral and mixed. At the first form of a Thrombangiitis obliterans vessels or the main arteries of extremities with characteristic symptoms of arterial ischemia of legs, the migrating thrombophlebitis, a Crocq's disease, formation of ulcers are surprised. At the mixed form along with signs of defeat of vessels of extremities symptoms of damage of heart, vessels of a brain, kidneys, changes in lungs, abdominal symptomatology are observed.

During an initial stage of a Thrombangiitis obliterans functional changes in extremities are observed: chill of legs, feeling of numbness, feeling of "goosebumps". Patients note an anesthesia of fingers, a posineniye and pain. At defeat of vessels of legs the symptom of the alternating lameness - sharp painful feelings in gastrocnemius muscles appears during walking.

Against the background of a course of a disease of the Burgher trophic frustration can be observed: hyperhidrosis, anhidrosis, hyperpegmentation, hypostases, atrophy of skin, muscles, necroses, trophic ulcers, gangrene.

Diagnosis of a Thrombangiitis obliterans

Often diagnosis of a Thrombangiitis obliterans has the excluding character (in cases when the impossibility of existence of other diseases at above-mentioned symptoms is proved). The diagnosis of an obliterating thromboangitis can be made with the following aspects:

• The age of the patient is younger than 40-45 years;
• The existence of signs of insufficient blood circulation in tissues of extremities with pains, lameness, ulcers revealed by means of noninvasive methods of a research (for example, ultrasonography with effect of a dopler);
• Exception of the diseases connected with disturbance of coagulability of blood, autoimmune diseases, a diabetes mellitus;
• Pathological processes of similar character come to light both in the patient, and in the seeming healthy extremity.

Apply the following to functional trials which would demonstrate disturbances of blood supply of extremities:

• Symptom of plantar ischemia of Oppel (blanching of the affected extremity raised up);
• Goldflam's test (the patient in a dorsal decubitus carries out exercises on bending and extension of knee and coxofemoral joints. At the expressed blood circulation disturbance the patient feels fatigue after 10 manipulations);
• Knee phenomenon of Panchenko (the patient in a sitting position, having thrown back a sore leg on healthy, begins to feel feelings of numbness, pain in the affected extremity).

Treatment of a Thrombangiitis obliterans

Now effective methods of treatment of a Thrombangiitis obliterans do not exist. At early stages of an obliterating thromboangitis specialists recommend to perform the conservative treatment connected with:

• Elimination of impact on a disease of etiological factors (in particular, smoking cessation);
• Removal of pains;
• Elimination of a vasospasm by means of ganglioblokator and spasmolysants;
• Normalization of processes of coagulability of blood, improvement of its rheological properties;
• Improvement of metabolic processes in fabrics.

In case of lack of positive effect from conservative therapy there are premises to performing surgery. For the purpose of a spasmolysis of peripheral arteries surgeons carry out a lumbar sympathectomy. In case of involvement in pathological process of vessels of upper extremities the chest sympathectomy is carried out. There is also information on positive impact on disease of the Burgher of hyperbaric oxygenation and a plasma exchange, however, these methods standard are not.

Efficiency of an alternative technique of treatment of the Thrombangiitis obliterans passing clinical tests - injections of stem cells - is still not confirmed officially.

Emergence of necroses and gangrene on the affected extremities is the indication to amputation. Statistically, about 35% of the patients having this diagnosis are not possible to avoid surgical removal of extremities.

Recommendations

The person suffering from a Thrombangiitis obliterans has to leave off smoking immediately - otherwise the disease will only progress. Besides, the patient should avoid injuries of skin because of influence of the high or low temperatures, chemicals, defeats connected with wearing inconvenient footwear, carrying out small operations (for example, removal of a callosity), fungal infections.

Short walking (20-30 minutes) several times a day is recommended to all patients (except patients with existence of ulcers and gangrenes on the affected extremities).