BUERGER’S DISEASE

• It is an inflammatory occlusive vascular disorder involving small and medium sized arteries and veins in the distal and lower extremities. Also called Thromboangitis obliterans (TAO)
• TAO most commonly affects adult males with a significant history of cigarette smoking. In susceptible individuals, smoking causes inflammation of the tunica intima of small vessels by an unknown mechanism, which results in thrombotic occlusion of the vessel
• Patients initially present with a classic triad of intermittent claudication, Raynaud phenomenon, and migratory thrombo phlebitis.
• Eventually, critical limb ischemia develops and the patient presents with rest pain, absent pulse in the extremities, and/or digital gangrene. Cerebral, visceral and coronary vessels are rarely affected

• Smoking is the single most important risk factor for TAO.

Patients may present with acute limb ischemia and/or symptoms of chronic peripheral artery disease

• Inflammation of the tunica intima with neutrophilic infiltration and micro abscess formation (endarteritis) leads to inflammation that may also spread to the tunica media but the internal elastic lamina usually remains intact 

• The rest of the vessel wall is usually relatively spared and development of cell-rich, inflammatory thrombi in the lumen causes occlusion of the vessel

• Mononuclear cells, fibroblasts, and giant cells replace neutrophils. Contiguous extension of the inflammatory process to the adjacent vein and nerve, resulting in the encasement of the artery, vein, and nerve in a fibrous sheath 

Early manifestations:

• Triad of Intermittent claudication of affected extremity
• Raynaud’s phenomenon and
• Migratory superficial vein thrombo phlebitis

Late manifestations 

• Rest pain
• Cool peripheral extremities
• Trophic nail changes
• Ulceration and/or gangrene of fingertips and/or toes (digits may auto amputate) 
• Normal brachial and popliteal pulses but poor/absent radial, ulnar, anterior tibial, posterior tibial, and/or dorsal pedis pulsations 

• ESR and CRP are within normal limits. 
• Autoantibodies (e.g., ANA, RF) are absent
• Doppler ultrasound
• Arteriography : Shows non-atherosclerotic, smooth, tapering, segmental lesions that occlude distal vessels of extremities

• Complete cessation of smoking and the use of tobacco
• Protection of fingers and toes from cold to prevent Raynaud phenomenon

Internal Medicines

• Manjishtadi Kashaya
• Saptasara kashaya
• Guggulu thiktaka kashaya
• Kaisora guggulu
• Amrutha guggulu
• Chandraprabha gutika
• Madhuyashtyadi taila
• Maharaja prasarani taila
• Ksheerabala taila
• Partharishta
• Guggulu panchapala choorna

Procedures

• Dashamoola kashaya dhara