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Buerger’s Disease (Thromboangiitis Obliterans)

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Systemic Vasculitides: Current Status and Perspectives

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Abstract

Buerger’s disease (also known as thromboangiitis obliterans) is a non-atherosclerotic, inflammatory, segmental peripheral vascular occlusive disease that typically affects young male smokers. The patients typically present with ischemic symptoms caused by stenosis or occlusion of the distal small arteries. Superficial thrombophlebitis often occurs, which is migratory and frequently correlates with disease activity. The disease escalates usually at the age of 30–40 years and thereafter symptoms diminish. This disease had been more frequently reported in the Mediterranean, Middle East, and Far East Asia, but the number of patients is decreasing.

There are two characteristic histopathological findings. One is that inflammatory infiltrating cells are well recognized, predominantly in the thrombi and the intima. The other is that the internal elastic lamina and all layers of the vessel wall structures are well preserved. Buerger’s disease is distinguishable from atherosclerosis and other vasculitides by this characteristic preserved elastic lamina. There are several clinical diagnostic criteria for Buerger’s disease, which mostly require a compatible history, supportive physical findings, diagnostic vascular abnormalities on imaging studies, and current or past smoking.

The etiology of Buerger’s disease still remains to be elucidated and no therapeutic guidelines exist. However, smoking clearly associates with its exacerbation and remission. Absolute smoking cessation is the one and only definitive therapy for Buerger’s disease.

The fate of ischemic limb in Buerger’s disease is not so poor compared to that in atherosclerotic disease, provided that the patients maintain smoking cessation. As for the life expectancy, long-term survival is generally considered not to be affected by Buerger’s disease, due to the rare involvement of cerebral, coronary, and visceral arteries.

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References

  1. Borner C, Heidrich H (1998) Long-term follow-up of thromboangiitis obliterans. VASA 27:80–86

    CAS  PubMed  Google Scholar 

  2. Buerger L (1908) Thromboangiitis obliterans: a study of the vascular lesions leading to presenile spontaneous gangrene. Am J Med Sci 136:567–580

    Article  Google Scholar 

  3. Chen YW, Umeda M, Nagasawa T, Takeuchi Y, Huang Y, Inoue Y et al (2008) Periodontitis may increase the risk of peripheral arterial disease. Eur J Endovasc Surg 35:153–158

    Article  CAS  Google Scholar 

  4. de Moerloose P, Jeannet M, Mirimanoff P, Bouvier CA (1979) Evidence for an HLA-linked resistance gene in Buerger’s disease. Tissue Antigens 14:169–173

    Google Scholar 

  5. Desbois AC, Cacoub P (2013) Cannabis-associated arterial disease. Ann Vasc Surg 27:996–1005

    Article  PubMed  Google Scholar 

  6. Eichhorn J, Sima D, Linschau C, Turowski A, Schmidt H, Schneider W et al (1998) Antiendothelial cell antibodies in thromboangiitis obliterans. Am J Med Sci 315:17–23

    CAS  PubMed  Google Scholar 

  7. Fiessinger JN, Schafer M (1990) Trial of iloprost versus aspirin treatment for critical limb ischaemia of thromboangiitis obliterans. The TAO Study. Lancet 335:555–557

    Article  CAS  PubMed  Google Scholar 

  8. Grotenhermen F (2010) Cannabis-associated arteritis. VASA 39:43–53

    Article  CAS  PubMed  Google Scholar 

  9. Gulati SM, Singh KS, Thusoo TK, Saha K (1979) Immunological studies in thromboangitis obliterans (Buerger’s disease). J Surg Res 27:287–293

    Google Scholar 

  10. Haga E (1889) Spontaneous gangrene in Japan. J Tokyo Med Assoc 3:419–422, 560–565, 630–3, 1217–21, 1346–53 (in Japanese)

    Google Scholar 

  11. Haga E (1898) Über spontane Gangräne. Arch Pathol Anat 152:26–60 (in German)

    Google Scholar 

  12. Halacheva K, Gulubova MV, Manolova I, Petkov D (2002) Expression of ICAM-1, VCAM-1, E-selectin and TNF-alpha on the endothelium of femoral and iliac arteries in thromboangiitis obliterans. Acta Histochem 104:177–184

    Article  CAS  PubMed  Google Scholar 

  13. Igari K, Inoue Y, Iwai T (2016) The epidemiologic and clinical findings of patients with buerger disease. Ann Vasc Surg 30:263–269

    Article  PubMed  Google Scholar 

  14. Inaba S, Egashira K, Komori K (2002) Peripheral-blood or bone-marrow mononuclear cells for therapeutic angiogenesis? Lancet 360:2083

    Article  PubMed  Google Scholar 

  15. Isner JM, Baumgartner I, Rauh G, Schainfeld R, Blair R, Manor O et al (1998) Treatment of thromboangiitis obliterans (Buerger’s disease) by intramuscular gene transfer of vascular endothelial growth factor: preliminary clinical results. J Vasc Surg 28:964–973

    Google Scholar 

  16. Iwai T, Inoue Y, Umeda M, Huang Y, Kurihara N, Koike M et al (2005) Oral bacteria in the occluded arteries of patients with Buerger disease. J Vasc Surg 42:107–115

    Article  PubMed  Google Scholar 

  17. Iwai T, Sato, Kume H, Inoue Y, Umeda M, Kagayama T et al (2012) Clinical study of Phlebitis migrans and incompetence of the leg’s superficial vein in Buerger disease. Ann Vasc Dis 5:45–51

    Google Scholar 

  18. Iwai T (2009) Periodontal bacteremia and various vascular diseases. J Periodontal Res 44:689–694

    Article  CAS  PubMed  Google Scholar 

  19. Joras M, Poredos P, Fras Z (2006) Endothelial dysfunction in Buerger’s disease and its relation to markers of inflammation. Eur J Clin Investig 36:376–382

    Google Scholar 

  20. Kobayashi M, Ito M, Nakagawa A, Nishikimi N, Nimura Y (1999) Immunohistochemical analysis of arterial wall cellular infiltration in Buerger’s disease (endarteritis obliterans). J Vasc Surg 29:451–458

    Article  CAS  PubMed  Google Scholar 

  21. Kobayashi M, Nishikimi N, Komori K (2006) Current pathological and clinical aspects of Buerger’s disease in Japan. Ann Vasc Surg 20:148–156

    Article  PubMed  Google Scholar 

  22. Kurata A, Machinami R, Schulz A, Fukayama M, Franke FE (2003) Different immunophenotypes in Buerger’s disease. Pathol Int 53:608–615

    Article  PubMed  Google Scholar 

  23. Lazarides MK, Georgiadis GS, Papas TT, Nikolopoulos ES (2006) Diagnostic criteria and treatment of Buerger’s disease: a review. Int J Low Extrem Wounds 5:89–95

    Article  CAS  PubMed  Google Scholar 

  24. Lee T, Seo JW, Sumpio BE, Kim SJ (2003) Immunobiologic analysis of arterial tissue in Buerger’s disease. Eur J Vasc Endovasc Surg 25:451–457

    Article  CAS  PubMed  Google Scholar 

  25. Lie JT (1988) Thromboangiitis obliterans (Buerger’s disease) revisited. Pathol Annu 23:257–291

    PubMed  Google Scholar 

  26. Makita S, Nakamura M, Murakami H, Komoda K, Kawazoe K, Hiramori K (1996) Impaired endothelium-dependent vasorelaxation in peripheral vasculature of patients with thromboangiitis obliterans (Buerger’s disease). Circulation 94:II211–II215

    Google Scholar 

  27. Małecki R, Zdrojowy K, Adamiec R (2009) Thromboangiitis obliterans in the 21st century–a new face of disease. Atherosclerosis 206:328–334

    Google Scholar 

  28. Matoba S, Tatsumi T, Murohara T, Imaizumi T, Katsuda Y, Ito M et al (2008) Long-term clinical outcome after intramuscular implantation of bone marrow mononuclear cells (Therapeutic Angiogenesis by Cell Transplantation [TACT] trial) in patients with chronic limb ischemia. Am Heart J 156:1010–1018

    Article  PubMed  Google Scholar 

  29. Matsushita M, Shionoya S, Matsumoto T (1991) Urinary cotinine measurement in patients with Buerger’s disease--effects of active and passive smoking on the disease process. J Vasc Surg 14:53–58

    Google Scholar 

  30. Matsushita M, Nishikimi N, Sakurai T, Nimura Y (1998) Decrease in prevalence of Buerger’s disease in japan. Surgery 124:498–502

    Article  CAS  PubMed  Google Scholar 

  31. Maurya SD, Singhal S, Gupta HC, Elhence IP, Sharma BD (1985) Pedicled omental grafts in the revascularization of ischemic lower limbs in Buerger’s disease. Int Surg 70:253–255

    Google Scholar 

  32. McLoughlin GA, Helsby CR, Evans CC, Chapman DM (1976) Association of HLA-A9 and HLA-B5 with Buerger’s disease. Br Med J 2:1165–1166

    Google Scholar 

  33. Mills JL, Taylor LM Jr, Porter JM (1987) Buerger’s disease in the modern era. Am J Surg 154:123–129

    Article  CAS  PubMed  Google Scholar 

  34. Mills JL, Porter JM (1991) Buerger’s disease (thromboangiitis obliterans). Ann Vasc Surg 5:570–572

    Google Scholar 

  35. Mills JL, Porter JM (1993) Buerger’s disease: a review and update. Semin Vasc Surg 6:14–23

    Google Scholar 

  36. Nishikimi N (2000) Fate of limbs with failed vascular reconstruction in Buerger’s disease patients. Int J Cardiol 75(Suppl 1):S183–S185

    Article  Google Scholar 

  37. Ohta T, Ishioashi H, Hosaka M, Sugimoto I (2004) Clinical and social consequences of Buerger disease. J Vasc Surg 39:176–180

    Article  PubMed  Google Scholar 

  38. Olin JW, Young JR, Graor RA, Ruschhaupt WF, Bartholomew JR (1990) The changing clinical spectrum of thromboangiitis obliterans (Buerger’s disease). Circulation 82:IV3–IV8

    Google Scholar 

  39. Olin JW (2000) Thromboangiitis obliterans (Buerger’s disease). N Engl J Med 343:864–869

    Google Scholar 

  40. Olin JW, Shih A (2006) Thromboangiitis obliterans (Buerger’s disease). Curr Opin Rheumatol 18:18–24

    Article  PubMed  Google Scholar 

  41. Papa M, Bass A, Adar R, Halperin Z, Schneiderman J, Becker CG et al (1992) Autoimmune mechanisms in thromboangiitis obliterans (Buerger’s disease): the role of tobacco antigen and the major histocompatibility complex. Surgery 111:527–531

    CAS  PubMed  Google Scholar 

  42. Papa MZ, Rabi I, Adar R (1996) A point scoring system for the clinical diagnosis of Buerger’s disease. Eur J Vasc Endovasc Surg 11:335–339

    Google Scholar 

  43. Saito S, Nishikawa K, Obata H, Goto F (2007) Autologous bone marrow transplantation and hyperbaric oxygen therapy for patients with thromboangiitis obliterans. Angiology 58:429–434

    Article  PubMed  Google Scholar 

  44. Sasajima T, Kubo Y, Inaba M, Goh K, Azuma N (1997) Role of infrainguinal bypass in Buerger’s disease: an eighteen-year experience. Eur J Vasc Endovasc Surg 13:186–192

    Article  CAS  PubMed  Google Scholar 

  45. Shigematsu H, Shigematsu K (1999) Factors affecting the long-term outcome of Buerger’s disease (thromboangiitis obliterans). Int Angiol 18:58–64

    CAS  PubMed  Google Scholar 

  46. Shionoya S (1990) Pathology. In: Shionoya S (ed) Buerger’s disease. The University of Nagoya Press, Nagoya, pp 57–79

    Google Scholar 

  47. Singh I, Ramteke VK (1996) The role of omental transfer in Buerger’s disease: New Delhi’s experience. Aust N Z J Surg 66:372–376

    Google Scholar 

  48. Smolen JS, Youngchaiyud U, Weidinger P, Kojer M, Endler AT, Mayr WR et al (1978) Autoimmunological aspects of thromboangiitis obliterans (Buerger’s disease). Clin Immunol Immunopathol 11:168–177

    Google Scholar 

  49. Sugimoto M, Miyachi H, Morimae H, Kodama A, Narita H, Banno H et al (2015) Fate of ischemic limbs in patients with Buerger’s disease based on our 30-year experience: does smoking have a definitive impact on the late loss of limbs?. Surg Today 45:466–470

    Google Scholar 

  50. Tanaka K (1998) Pathology and pathogenesis of Buerger’s disease. Int J Cardiol 66:S237–S242

    Article  PubMed  Google Scholar 

  51. Wessler S, Ming SC, Gurewich V, Freiman DG (1960) A critical evaluation of thromboangitis obliterans. The case against Buerger’s disease. N Engl J Med 262:1149–1162

    Google Scholar 

  52. Winiwarter F (1878) Über eine eigentümliche Form von Endarteritis und Endophlebitis mit Gangrän des Fusses. Arch kiln Chir 23:202–26 (in German)

    Google Scholar 

  53. Yörükoğlu Y, Ilgit E, Zengin M, Nazliel K, Salman E, Yucel E (1993) Thromboangiitis obliterans (Buerger’s disease) in women (a reevaluation). Angiology 44:527–532

    Google Scholar 

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Authors and Affiliations

  1. Division of Vascular Surgery, Department of Surgery, Nagoya University Graduates School of Medicine, 65, Tsurumaicho, Showa-ku, Nagoya, 466-8550, Japan

    Masayuki Sugimoto & Kimihio Komori

Authors
  1. Masayuki Sugimoto
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  2. Kimihio Komori
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Correspondence to Kimihio Komori .

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Editors and Affiliations

  1. University of Bari Medical School, Bari, Italy

    Franco Dammacco

  2. University of Bari Medical School, Bari, Italy

    Domenico Ribatti

  3. University of Bari Medical School, Bari, Italy

    Angelo Vacca

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Sugimoto, M., Komori, K. (2016). Buerger’s Disease (Thromboangiitis Obliterans). In: Dammacco, F., Ribatti, D., Vacca, A. (eds) Systemic Vasculitides: Current Status and Perspectives. Springer, Cham. https://doi.org/10.1007/978-3-319-40136-2_31

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