Thromboangiitis obliterans (Buerger’s disease) 血栓闭塞性脉管炎(伯格病)

Thromboangiitis obliterans, also known as Buerger’s disease, is an inflammatory disease that result in blood clot formation (thrombosis) in small and medium-sized arteries. The affected areas are most commonly found on the hands and feet [1-3]. This disease is strongly associated with the use of tobacco products thus smoking cessation is important to decrease the risk for the need of amputation. For those who don’t quit, amputation of all or some part of a limb are sometimes necessary [4-7].

We describe a case of a 50-year-old-male presented with left index finger distal extremity ischemic ulceration and necrosis. His prior treatments, a calcium channel blocker amlodipine, did not improve his symptoms. Tangs herbal medicine was administrated 2 times daily. The necrosis and ischemia resolved completely by 12 months after the initial presentation.

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Hand arteriogram in thromboangiitis obliterans, The Digital Substraction Angiogram shows occlusions of the digital arteries, with collateralization “corkscrew collaterals” around the areas of occlusion (arrow). 血栓闭塞性脉管炎的手动脉造影，数字减影血管造影显示指端动脉闭塞，闭塞区域近段有“螺旋状侧支”（箭头所指）。

血栓闭塞性脉管炎，也称为伯格病，是一种炎症性疾病，可导致中小动脉形成血栓凝块。受影响的区域最常见的是手脚末端 [1-3]。这种疾病与烟草制品的使用密切相关，戒烟对于降低截肢风险很重要。对于那些不戒烟的人，有时需要截肢全部或部分肢体 [4-7]。

我们接诊了一位 50 岁男性布尔格氏病例，他左手食指远端缺血性溃疡和坏死。他之前的治疗包括一些钙通道阻滞剂氨氯地平，但没有改善他的症状。唐氏中医植物草药每天给药口服2次。坏死和缺血在初次就诊后的第 12 个月完全消退。

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Reference:

  1. Buerger L. Landmark publication from the American Journal of the Medical Sciences, ‘Thrombo-angiitis obliterans: a study of the vascular lesions leading to presenile spontaneous gangrene’. 1908. Am J Med Sci 2009; 337:274.
  2. Piazza G, Creager MA. Thromboangiitis obliterans. Circulation 2010; 121:1858.
  3. Dargon PT, Landry GJ. Buerger’s disease. Ann Vasc Surg 2012; 26:871.
  4. Grove WJ, Stansby GP. Buerger’s disease and cigarette smoking in Bangladesh. Ann R Coll Surg Engl 1992; 74:115.
  5. Mills JL, Porter JM. Buerger’s disease (thromboangiitis obliterans). Ann Vasc Surg 1991; 5:570.
  6. Papa M, Bass A, Adar R, et al. Autoimmune mechanisms in thromboangiitis obliterans (Buerger’s disease): the role of tobacco antigen and the major histocompatibility complex. Surgery 1992; 111:527.
  7. Tavakoli H, Rezaii J, Esfandiari K, et al. Buerger’s disease: a 10-year experience in Tehran, Iran. Clin Rheumatol 2008; 27:369.