[Clinical diagnosis, special characteristics and therapy of Buerger's disease]

Some authors still doubt that the Buerger's disease is an independent disease entity and differs principally from obliterating atherosclerosis. This is why the author draws attention to many specific characteristics of this disease and differences which distinguish it from atherosclerosis of peripheral arteries. After some introductory notes the author presents that the prevalence of thrombangiitis in Europe ranges from 0.5 to 2% out of all ischemic diseases of limbs, while in Japan it reaches 20-30%. Previously the ratio of affliction of men and women was 100:1; presently some authors present the ratio being 10:1. The upper limbs are usually afflicted by this disease much more often than by obliterating atherosclerosis, and frequently already at the beginning of the disease. The main and only proved risk factor is smoking. However a predisposition is necessary (the predisposition is more frequent in the yellow race). The Buerger's disease is an autoimmune disease responding to the antigen-antibody complex. Laboratory results are positive in coincidence with inflammatory markers, especially in recurrent cases. Histology appoints to inflammatory vascular lesions, sometimes accompanied by a positive finding of IgG deposits, IgM, and immunocomplexes. Clinically, particularly peripheral vessels are afflicted, the disease is initiated usually before 40 years of age and is of a typical arteriographic pattern. It is also characteristic for its migrating phlebitis. The clinical picture has some specific features. The disease can be localized also in the coronary, cerebral and visceral arteries. Besides the general procedures in ischemic diseases of the limbs, the therapy must necessarily, respect also some particulars, as e.g. antiinflammatory therapy (antibiotics, antirheumatics, corticoids) and some specific surgical procedures. (Ref. 75.)