Seasonal variation of Buerger's disease in Northern part of Thailand

Buerger’s Disease May be a Chronic Rickettsial Infection with Superimposed Thrombosis: Literature Review and Efficacy of Doxycycline in Three Patients

Buerger’s disease (BD) is a chronic inflammatory vasculitis of unknown etiology. The infectious etiology of BD was proposed by Buerger in 1914. Furthermore, there are scattered reports insisting that BD may be related to rickettsial infection, first asserted by Goodman since 1916, followed by Giroud and other French investigators from the 1940s through the 1960s, Nicolau in the 1960s, Bartolo (1980s), and Fazeli (2010s). However, their causal relationship has hardly been accepted because rickettsial infections are known to be acute febrile, vector-borne illnesses, whereas BD is a chronic afebrile illness. In this article we review the relevant literature on the chronic nature of Rickettsia and Orientia infections and on the rickettsial etiology of BD. Excellent initial responses to doxycycline in three patients with BD are briefly described. Based on these findings, we hypothesize that BD patients acquired a rickettsial infection far before the onset of BD. Over years, the infected area expands to become a segment of the infected vessel. Subsequently, thrombus develops on the luminal surface of the infected endothelial cells, which produces the vascular obstructive manifestations of BD. Collectively, it is postulated that BD is a chronic infection with a member of the family Rickettsiaceae with superimposed thrombosis.

Lower-extremity Arterial Thrombosis Associated with COVID-19 Is Characterized by Greater Thrombus Burden and Increased Rate of Amputation and Death

Background During the peak of the coronavirus disease 2019 (COVID-19) pandemic, the authors noted an increase in positive lower-extremity CT angiography examinations in patients who presented with leg ischemia. The goal of this study was to determine whether lower-extremity arterial thrombosis was associated with COVID-19 and whether it was characterized by greater severity in these patients. Materials and Methods In this retrospective propensity score-matched study approved by the institutional review board, 16 patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and who underwent CT angiography of the lower extremities and 32 patients who tested negative for SARS-CoV-2 observed from January to April 2018, January to April 2019, and January to April 2020 were compared using three scoring systems: two systems including all vessels, with weighting in one system given to more proximal vessels and with weighting in the other system given to more distal vessels, and a third system in which only the common iliac through popliteal arteries were considered. Correlation with presenting symptoms and outcomes was computed. Fisher exact tests were used to compare patients who tested positive for COVID-19 with patients who tested negative for COVID-19 regarding the presence of clots and presenting symptoms. A Mantel-Haenszel test was used to associate outcome of death and/or amputation with COVID-19 adjusted according to history of peripheral vascular disease (PVD). Results Sixteen patients with confirmed COVID-19 (70 years ± 14 [standard deviation]; seven women) who underwent CT angiography and 32 propensity score-matched control patients (71 years ± 15; 16 women) were included. All patients with COVID-19 (100%, 95% confidence interval [CI]: 79%, 100%) had at least one thrombus, and only 69% of control patients (95% CI: 50%, 84%) had thrombi (P = .02). Ninety-four percent of patients with COVID-19 (95% CI: 70%, 99.8%) had proximal thrombi compared with 47% of control patients (95% CI: 29%, 65%) (P < .001). The mean thrombus score using any of the three scoring systems yielded greater scores in patients with COVID-19 (P < .001). Adjusted for history of PVD, death or limb amputation was more common in patients with COVID-19 (odds ratio = 25; 95% CI: 4.3, 147; P < .001). Patients with COVID-19 who presented with symptoms of leg ischemia only were more likely to avoid amputation or death than patients who also presented with pulmonary or systemic symptoms (P = .001). Conclusion Coronavirus disease 2019 is associated with lower-extremity arterial thrombosis characterized by a greater clot burden and a more dire prognosis. © RSNA, 2020.

Imaging appearances of Buerger's disease complications in the upper and lower limbs

Thromboangiitis obliterans (Buerger's disease) is a rare, non-atherosclerotic, segmental, inflammatory vasculitis that most commonly involves small and medium-sized arteries, veins and nerves of the extremities and affects tobacco smokers between the ages of 25 and 45 years. The manifestations of Buerger's disease can be extremely variable and, therefore, awareness of the condition is important for both general and musculoskeletal radiologists. This paper presents the radiological appearance of the sequelae of Buerger's disease involving the upper and lower limbs.

Thromboangiitis obliterans in the 21st century--a new face of disease

Thromboangiitis obliterans (TAO) is a relatively rare disease of peripheral blood vessels, affecting small and medium sized arteries and veins. Although the first description of the disease was given by Winiwarter almost 130 years ago, etiology of TAO remains not elucidated. Smoking is considered as a precipitating factor of the disease. We emphasised some particular features of the new face of TAO - significant decrease in incidences, increased disease prevalence among women and coexistence of other than smoking atherosclerotic risk factors (especially disturbances of glucose metabolism). Contemporary methods of treatment were also discussed.

Buerger's disease: a 10-year experience in Tehran, Iran

The clinical spectrum of Buerger's disease (TAO; thromboangiitis obliterans) seems to be changing. Considering the lack of any formal studies on the epidemiology of this disease in Iran, we evaluated the data of 198 confirmed cases of TAO during the period 1996-2006. Diagnosis was based on Papa's scoring system. All patients were male and aged at the time of diagnosis 40.5 +/- 10.1 years. All patients were smokers for a duration of 22.2 +/- 11.6 years. There was a strong seasonal variation for admission with winter admissions being significantly the most common (P < 0.001). Patients, 181 (91.4%), had only lower limb involvement, 4 (2.0%) had solely upper limb disease, and 13 (6.6%) suffered from both. Sympathectomy, amputation, and bypass graft surgery were performed in 97 (49.0%; lumbar: 92, thoracic: 5), 71 (35.9%), and 28 (14.1%) patients, respectively. The present report is the second one to show seasonal variation in TAO.

Thromboangiitis obliterans (Buergerʼs disease)

PURPOSE OF REVIEW

Thromboangiitis obliterans is a nonatherosclerotic segmental inflammatory disease that affects the small and medium-sized arteries and veins in the upper and lower extremities. This review will help to familiarize physicians with this vasculitis that is completely different from every other type of vasculitis encountered.

RECENT FINDINGS

While tobacco is central to the initiation and continuance of Buerger's disease activity, two interesting pathophysiologic observations have been made. There is endothelial dysfunction in arteries not yet clinically or angiographically involved in thromboangiitis obliterans. There are elevated levels of anti-endothelial cell antibodies and measurement of these antibody titers may be useful in following disease activity in Buerger's disease patients. The only therapy clearly shown to prevent amputation is the complete abstinence of tobacco. There is exciting work under way on the use of selective cannabinoid receptor antagonists to help patients stop smoking. In addition, preliminary results on use of therapeutic angiogenesis in patients with Buerger's disease has demonstrated excellent collateral blood vessels formation and clinical improvement.

SUMMARY

The difficulty in studying rare diseases such as thromboangiitis obliterans is that there are no significant research dollars available and even the most active centers only see a few patients per year. Therefore, there has been little progress in understanding the pathogenesis of the disease. There are new therapeutic modalities that help patients with this disease, however, and patients can be assured that if they are able to discontinue tobacco use completely, amputation will not occur if critical limb ischemia is not already present.

Decrease in the Incidence of Buerger's Disease Recurrence in Northern Thailand

PURPOSE

Buerger's disease is a peripheral arterial occlusive disease (PAOD), which occurs mainly in young male smokers. It is common in Asia, the Middle East, and Eastern European countries, but rare in North America and Western European countries. We investigated the changes in the prevalence and recurrence of Buerger's disease at a referral hospital in northern Thailand.

METHODS

We conducted a retrospective study of patients with Buerger's disease admitted to Chiang Mai University Hospital between January 1988 and December 2002. Buerger's disease was diagnosed according to Shionoya's clinical criteria.

RESULTS

We evaluated 78 patients with Buerger's disease, with a collective total of 108 admissions. Forty-one patients were admitted for initial treatment, and 37 patients had a history of treatment and were admitted for worsening of Buerger's disease. Between 1988 and 1995, 23 patients were admitted with newly diagnosed Buerger's disease, 52 were admitted because of Buerger's disease exacerbation, and 372 were admitted for a PAOD; whereas between 1996 and 2002, the respective numbers were 18, 15, and 632 (2.9 +/- 1.9/year vs 2.6 +/- 1.3/year, P = 0.25; 6.5 +/- 1.1/year vs 2.1 +/- 1.1/year, P = 0.001; 54.1 +/- 6.7/year vs 81.6 +/- 5.2/year, P < 0.0001). Of the 78 patients with Buerger's disease, 76 were men and 2 were women, with a mean age at onset of 34.1 +/- 5 years. The predominant symptom on admission was burning pain in the feet and hands in 75%, digital gangrene in 74%, and a digital ulcer in 43.5%.

CONCLUSIONS

The incidence of recurrence of Buerger's disease seems to be decreasing in our institution, whereas the incidence of this disease and its recurrence both seem to be decreasing in Western countries and Japan.

Enfermedad de Buerger (tromboangeítis obliterante)

Thromboangiitis obliterans (TAO) is a segmental, inflammatory, vasoocclusive disease that predominantly affects the small and medium-sized arteries and veins of the extremities. It most often occurs in young male smokers, especially those from Mediterranean and Asian countries. It is considered an autoimmune process related to the use of tobacco products. Clinically, it is characterized by the presence of painful, ischemic ulcers of the digits. Histopathological studies usually show an occlusive intraluminal thrombus with a predominantly acute inflammatory infiltrate. To make the diagnosis, it is important to exclude other causes of ischemia of the extremities, and different authors have proposed criteria to establish this diagnosis. Treatment is only effective if it is accompanied by abstention from tobacco. There are also different pharmacological and surgical strategies for its management.