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Buerger disease

Buerger disease (also known as the thromboangiitis obliterans) is a type of vasculitis that affects small and medium blood vessels and has been linked strongly to smoking. Buerger disease is characterised by poor blood flow through blood vessels due to inflammation and blood clotting. Symptoms typically include pain (claudication), increased sensitivity to cold, diminished pulses, and cyanosis. Gangrene is often a complication which may require amputation of the affected area. Learn how health care professionals diagnose Buerger disease using ultrasound and angiography. Created by Ian Mannarino.

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Video transcript

Voiceover: What would happen if you narrow the blood vessels in your fingers and in your hand? What would you see? What would happen? Well, of course we'd see decreased blood flow, which means decreased oxygen delivery to the tissues, right. Decreased oxygen delivery to your fingers, which can lead to pain. It's very similar to what happens in the heart. If you have decreased blood flow to the heart, then you can feel anginal pain, right. Angina, chest pain. Here, it's very similar, you get a muscular pain, which is known as claudications. Now, what happens if the blockage is so severe that you have complete blockage? It's no longer narrowed, it's just completely blocked off. Well, you're not going to get any more blood to your fingers, and so it makes sense, they're going to die. The cells in them are going to die, and your fingers will fall off. This is called autoamputation. These are two of the main symptoms found in the vasculitis called Buerger's disease. Recently, there's been a movement in Medicine in trying to rename diseases that are named after guys like Buerger. And they're trying to make it easier for people like us to understand medical terminology, and so they've tried to rename some diseases. In this case, they've renamed this thromboangiitis obliterans, so much for really help us understand what it means, right. Let's break it down. It may be a mouthful, but when we take a look at it, actually makes a lot of sense. Thrombo means clotting right. Angitis is inflammation of blood vessels, which is really the root of vasculitis. Remember vasculitis is vessel inflammation. Angitis is just another name for this. And lastly, obliterans, which is a term for artery occlusion or artery blockage. Obliterans pretty much just means blockage. So, here we've got clot formation, vessel inflammation, and blockage. We can think there is vessel inflammations, disease causing a clot, which creates a blockage in blood flow. And so you see these symptoms of claudication, autoamputation, death of the cells, necrotizing vasculitis. Other symptoms that you see are ischemic ulcers, gangrene. These are all terms for the same thing. Ischemic ulcer: Blood flow, blood decrease causing skin damage. Gangrene: Cell death of fingers and toes, damaged dead cells. This is not just the hands, actually the feet are involved as well. Most common symptom is forefoot pain, pain right here. Now, this can be diagnosed with an ultrasound. Taking a look with a probe and seeing what it displays on the screen. And here, we'll see narrowing of blood vessels. Not only that, you can also use an angiography. Angiography is a way to visualize the inside of blood vessels. What you do is you have a patient take this fluid called contrast that has a high radiological isotope. Basically, it can be seen when you use something like an x-ray or a scan, a radiological scan. And so it gets absorbed into your blood stream and allows physicians to visualize how the blood vessels look on the inside. So if there is a blockage in the artery, the physician will see this narrowing because there is less blood flow through an area. Another thing you can see in angiography is some spiraling. A cork screwing pattern of arteries around a blockage, so arteries create this cork screwing because they go through a pattern of growth, damage, regrowth. They're trying to create a new fresh artery. A risk factor of this disease is smoking. The pathophysiology isn't quite understood, but it's believed that something in the tobacco or something in the cigarette is causing the immune system to respond. And for some reason, vessels in your hands and your feet are affected. The only definitive treatment is to stop smoking. There is no medication that really can be given to stop the progress of this disease. So patients are urged to really quit. Otherwise, they may lose their fingers or toes. If that's not enough motivation, then I don't know what else would be.