Arteriographic findings of Buerger's disease

Oh, K K; Choi, B S; Suh, J H; Park, C Y

Abstract

In 1908, Leo Buerger impressed by the occurence of gangrene in a mumber of young men, delineated in this groupcertain, and he termed thromboangiitis obliterans. Distal arterial occulusive disease and/or recurrent superficialthrombophlebitis occuring in an adult male smoker, in the absence of known cause, constitutes a distinctive andunmistakable syndrome. It is very hard to differentiate TAO from AO (arteriosclerosis obliterans) as a result ofrecent careful morphologic and angiographic studies. That has been reevaluated entity known generally as Buerger's disease. Even, several American workers have suggested that Buerger's disease is not a definite clinical entityand now consider arteriosclerosis as the principal cause of chronic occlusive disease of peripheral arteries. Thedisease is characterized by : onset in the third and fourth decade of life ; preponderant frequency in males ;insidious progression; disproportionate amount of rest pain in relation to the objective signs of ischemia; avirtually invariable association with use of nicotine; involvement of distal small and medium sized arteries ofthe lower and; less commonly, of the upper extremity; frequent coexistence of thrombophlebitis; inflammatory andthrombotic changes in the affected arteries; and distinctive patterns of anatomical distribution of thepathological lesions giving distinctive angiographic images. There should be an absence of detectable cardiac orcerebral vascular disease, peripheral vascular calcification, hyperlipidemia, hypercholesterolemia, diabetesmellitus, cervical ribs, scalenus anticus syndrome, scleroderma, systemic lupus erythromatosus, or periarteritis,nodosa. The purpose of this paper is to discribe and analize the clinically and pathologically confirmed 28 casesin Dept. of Radiology and Nuclear Medicine in Severance Hospital after excluding other causes followed by chestX-ray, EKG, blood chemistry, and urinalysis. The results are: 1. Almost (96.4%) of the Buerger's patients weremale and the range of age is 20-50 years at the onset of symptoms. 2. Almost of them (85.7%) has the virtualhistory of invariable association with use of nicotine. 3. They included initial appearance of symptoms ofcoldness (75%), pain (64%), ulcer formation (54%), cyanosis (50%) and intermittent claudication. 4. In our series,the clinically involved abnormal pulsations were most commonly at dorsalis pedis artery(51%) and popliteal artery(30%) 5. The arteriographic findings in TAO in 28 our series, define the characteristic pattern of vascularocclusion, diffuse arterial narrowing, and arterial segmental occlusion, most commonly. The most frequent occludedsites are superficial femoral artery (41.2%) and popliteal artery (17.7%), and shows the actual vascularocclusions were higher in level than clinical site. 6. The arteries above the occluded site were regular in sizeand shape, however, often shows vascular corrugation which support the evidence of TAO, not AO. 7, Collateralsfrequently had a corkscrew configurations proximally and a tree-root appearance distally.