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[Thromboangiitis obliterans (Buerger's disease). Study of 41 cases]
C Fernández-Miranda1, R Rubio, J L Vicario
1Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid.
Insights
Thromboangiitis obliterans is a rare vascular disease. Clinical findings include limb ischemia, Raynaud's phenomenon, and increased HLA and anticollagen antibodies, with smoking worsening prognosis.
Area of Science:
- Vascular Medicine
- Immunology
- Epidemiology
Context:
- Thromboangiitis obliterans (Buerger's disease) is a rare inflammatory condition affecting small and medium-sized blood vessels, predominantly in smokers.
- Understanding its prevalence, clinical manifestations, and immunological associations is crucial for diagnosis and management.
Purpose:
- To determine the prevalence of thromboangiitis obliterans in Spain.
- To characterize the clinical and immunological features of the disease.
- To investigate the evolution and prognosis of thromboangiitis obliterans.
Summary:
- A study of 41 patients diagnosed between 1982-1990 revealed a prevalence of 11/100,000.
- Common symptoms include lower limb ischemia (100%), upper limb ischemia (34%), superficial thrombophlebitis (39%), and Raynaud's phenomenon (53%).
- Increased prevalence of HLA-B35, HLA-B40, and anticollagen antibodies was observed. Smoking cessation improved prognosis, though visceral artery involvement, particularly mesenteric ischemia, indicated a worse outcome.
Impact:
- This study highlights thromboangiitis obliterans as a rare but significant condition with potential for severe visceral artery involvement.
- Identifies specific HLA antigens and anticollagen antibodies as potential biomarkers.
- Emphasizes the critical role of smoking cessation in managing the disease and improving patient outcomes.
Background:
The aim of this study was to know the prevalence, clinical and immunological characteristics and evolution of thromboangiitis obliterans.
Methods:
Between 1982-1990 41 cases of thromboangiitis obliterans were diagnosed from among 373,899 patients registered (11/100,000) according to the clinical and arteriographic criteria. Of these 41 cases 40 were males with mean age 36 +/- 7 years (mean +/- SD) with only two cases being over 45 years of age. In 40 cases was followed for 44 +/- 29 months (mean +/- SD).
Results:
All the patients had ischemia of the lower limbs, 34% of the upper limbs, 39% superficial thrombophlebitis, 53% Raynaud's phenomenon, 5% mesenteric ischemia, and 7% myocardial infarction. In 30 symptomatic patients anticardiolipin antibodies were determined and one patient was positive for IgG antibodies. In the 23 patients in whom HLA and anticollagen antibody studies were performed a significant increase was found in HLA-B35, HLA-B40 and type VI denaturalized anticollagen antibodies compared to controls. In general the evolution was progressive when the patients continued smoking and favorable when tobacco was given up except in 2 cases who stopped smoking and in whom the disease progressed and death occurred. The total number of patients who died during follow up was 3 (7%), 2 due to mesenteric ischemia and the third during i.v. infusion of PGE1.
Conclusions:
The results demonstrate that thromboangiitis obliterans is a rare disease in Spain. The involvement of visceral arteries is not very infrequent with worse prognosis when the mesenteric arteries are involved. There is a significant increase of determined HLA antigens and anticollagen antibodies in the patients with thromboangiitis obliterans.