Internal Medicine

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

262 Buerger’s Disease

tests

Blood

■Serological studies to rule out:

➣Diabetes

➣Collagen vascular disease

➣Hyperlipidemia

➣Hypercoagulable state

Specific Diagnostic Studies

■Noninvasive vascular studies

■Decreased finger or toe pressures

■Normal proximal pressure (elbow or knee)

■Contrast arteriography

➣Rules out proximal lesions and defines:

➣Multiple distal obstructions

➣“corkscrew” collaterals

differential diagnosis

■Thromboembolic disease

■Popliteal artery entrapment

■Adventitial cystic disease

■Arteritis

➣All ruled out by angiography

■Accelerated atherosclerosis due to hypercoagulable state or diabetes

➣Ruled out by serum studies

management

What to Do First

■Smoking cessation is primary therapy

■Cessation of smoking is necessary and often sufficient for Buerger’s

disease to abate

General Measures

■Patient education regarding risk of limb loss and role of smoking

■Nicotine replacement therapy

■Formal smoking cessation program

■Skin care, careful fitting of shoes, cold avoidance

■Pain control

■Local wound care

➣Debridement of wet gangrene

➣Antibiotics for associated cellulitis

➣Dressing changes