Internal Medicine

0521779407-B02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Budd-Chiari Syndrome Buerger’s Disease 261

■surgical shunt: liver failure; hepatic encephalopathy

■OLT: usual complications

Prognosis

■2-year mortality with supportive medical therapy alone: 85–90%

■5-year survival with surgical shunt: 38–87% depending on continued

patency of graft, degree of fibrosis, type of shunt

■5-year survival with liver transplantation: 70%

Buerger’s Disease....................................

RAJABRATA SARKAR, MD

history & physical

History

■Young male smokers with finger or toe gangrene

■More common in Middle Eastern, Mediterranean and Far Eastern

populations

■Foot or calf claudication

■Ulceration or gangrene of toes or fingers

■Superficial venous thrombophlebitis

■Raynaud’s syndrome

Criteria for Clinical Diagnosis

■Smoking history

■Age less than 50

■Occlusive lesions below popliteal or brachial artery

■No trauma or proximal embolic source

■Normal proximal arteries

■Absence of risk factors for atherosclerosis (besides smoking)

➣Negative collagen vascular disease workup

➣No diabetes

➣No hyperlipidemia

■Negative hypercoagulable workup

Signs & Symptoms

■50% have gangrene of distal toes or fingers

■Pulses at wrist or ankle may be present

■Cold and tender fingers or toes

■Phlebitis in extremities

■Normal proximal pulses (femoral, axillary)