Thromboangiitis obliterans – causes, complaints & therapy

Thromboangiitis obliterans

Thromboangiitis obliterans is also known as endangitis obliterans or Winiwarter-Buerger’s disease. It is a relapsed inflammatory disease of the blood vessels. Presumably, thromboangiitis obliterans is an autoimmune disease.

What is thromboangiitis obliterans?

Thromboangiitis obliterans is characterized by intermittent vascular inflammation. Especially the small and medium blood vessels of the arms and legs are affected. Overall, the disease is rather rare. Only three to five percent of all arterial circulatory disorders are based on thromboangiitis obliterans.

Causes

The exact cause of the disease is still unclear. It is striking that the disease occurs particularly frequently in young, heavily nicotine-dependent men. The inhaled nicotine consumption and possibly also the inhaled carbon monoxide seem to be a contributing factor. Also under discussion are the direct damage to the vessel wall by carboxyhemoglobin (CO-Hb) and an allergic reaction to the ingredients of tobacco smoke.

Since abstaining from the cigarette in most cases quickly leads to a complete recovery, the pathogenetic relationship of nicotine consumption to thromboangiitis obliterans seems obvious. In addition, however, there seems to be a genuine willingness to ignite. An interaction of different genes, especially the genes HLA B5 and A9, with pollutants such as nicotine, seems plausible as a trigger of the disease.

Symptoms and course

Typical symptoms of thromboangiitis obliterans:

Obliterans thromboangiitis primarily affects men under 40 years of age. Almost all patients are smokers. Compared to the past, however, more and more women are reaching for cigarettes, so that now more and more women are falling ill. The disease can be acute, fulminant, subacute or chronic. Especially in the chronic and subacute forms, symptom-free intervals appear again and again. In thromboangiitis obliterans, the inner layer of blood vessels becomes inflamed.

In the course of inflammation, various cells accumulate in the affected blood vessels. In combination with the damage to the vessel, grafting occurs. The blood vessel becomes blocked, so that blood flow is no longer possible. As a result, circulatory disorders occur with an insufficient supply of the surrounding tissue. Those affected complain of cold feelings in the legs and arms and pain. The extremities can be colored blue and also show pain when touched. Raynaud’s syndrome may be observed.

This leads to a seizure of fading of the fingers or toes. Other symptoms of thromboangiitis obliterans are discomfort and superficial inflammation of the veins. Due to the lack of blood circulation, necrosis can form on the nails. Although the disease usually manifests itself on the arms or legs, there are also known cases in which vessels of the gastrointestinal tract, brain or heart were affected by the inflammation.

Diagnosis

To confirm the diagnosis, there is a specific laboratory test. In contrast to other vascular inflammations, the blood count shows neither an increased erythrocyte sedimentation rate nor an increase in C-reactive protein (CRP). Various examinations are carried out to rule out other diseases, in particular peripheral arterial occlusive disease (paVK) and diabetes mellitus.

These include liver function tests, fasting blood sugar, rheumatoid factors, serum creatinine levels, antinuclear antibodies, and serological markers of CREST syndrome. Angiography is also performed. An X-ray contrast agent is injected so that the following X-ray examination shows exactly which blood vessels are no longer properly permeable. Doppler sonography can also be used to visualize the flow direction and velocity of the blood in the affected vessels.

Shionoya’s diagnostic criteria include a history of nicotine, onset before the age of 50, occlusions within the arteries, involvement of the upper limb or inflammation of the veins, and the absence of other atherosclerosis risk factors such as obesity. If, despite all diagnostic steps, no reliable diagnosis can be made, an examination of the tissue is carried out. For this purpose, a small piece of tissue material is examined under the microscope. This shows the typical vascular changes of thromboangiitis obliterans.

Treatment and therapy

The most important therapy is an immediate renunciation of nicotine. This usually leads to a quick standstill and speedy recovery. If the patients continue to smoke, the prognosis of the disease is rather poor. Acetylsalicylic acid is given to thin the blood . Infusion therapies with prostaglandin E1 are also carried out. The aim of this drug therapy is to increase blood flow and thus bring more oxygen to the underserved areas.

With the help of nitroglycerin preparations, an attempt can also be made to slightly expand the diameter of the vessels. When tissue dies, antibiotics are given . This is to prevent wound infection . If treatment with antibiotics is unsuccessful, the affected extremity may have to be amputated. The amputation rate in severe cases of thrombangitis obliterans is about thirty percent.

Prevention

The most important prophylaxis of thromboangiitis obliterans is the renunciation of nicotine. Nicotine and tobacco smoke appear to have a negative effect on the vessels in different ways. The number of non-smokers suffering from thromboangiitis obliterans is negligible. So if you don’t reach for a cigarette, cigar or pipe, you have a good chance of staying healthy.

Dorothy Farrar

Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.

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