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Obliterating thromboangitis (Thrombangiitis obliterans)

The Obliterirushchy thromboangitis, or Thrombangiitis obliterans, represents inflammatory damage of arteries and veins of average and small caliber in the lower and upper extremities. The disease can be shown clinically by defeat of vessels only of hands or only legs. In rare instances cerebral, coronary and visceral arteries are involved in pathological process.

Traditionally was considered that the Thrombangiitis obliterans is observed at men of young age, as a rule, of smokers. However cases of this disease at women are observed in recent years that some connect with distribution of smoking among women.

The etiology of a disease is not found out, there are instructions for a role of hereditary factors, in particular, of a carriage of HLA antigens — A9 and B5. It is reported about emergence in the sick antibodies directed against collagen I, III and IV of types, and also against elastin and laminin.

Pathomorphologically the inflammation of small and average arteries and veins of extremities is observed, the process segmentarnost is expressed, in vessels blood clots can be formed. The late stage is characterized by perivascular fibrosis, an obliteration of a gleam of vessels though also the rekanalization of part of the affected arteries is at the same time possible. Inflammatory process proceeds wavy — within months, years and leads to occlusion of arteries.

Clinical manifestations of an obliterating thromboangitis

The disease develops generally at young men (seldom at women) aged till forty years though can occur also at later age, and also at teenagers. Damage of two lower and/or two upper extremities — since distal departments with distribution proksimalno is always observed. The triad is very characteristic: the alternating lameness, Reynaud's syndrome and the migrating superficial thrombophlebitis in distal parts of extremities. The alternating lameness is shown by pains when walking in raising of foot and lower part of gastrocnemius muscles; in case of damage of upper extremities during the work as hands there are pains in muscles of a brush and a forearm ("the alternating lameness" of upper extremities).

Hypersensitivity of brushes and feet to cold, sharp blanching of fingers of feet and brushes when cooling is observed; fingers can be cyanochroic, painful small knots and hemorrhages on small pillows of fingers appear. Not all fingers are surprised to the same extent that it is connected with irregularity of defeat of an arterial bed. There can be pale and cold not only fingers, but also feet and brushes. At heavy ischemia pains in distal departments of extremities at rest, trophic damages of nails, painful ulcerations and even gangrene of finger-tips develop; spontaneous amputation of nekrotizirovanny sites is possible. Severe damages of fingers can be provoked by an injury.

Often lack of pulse (or considerable decrease in a pulsation) on arteries of legs — a. dorsalis pedis, a. tibialis posterior and on arteries of hands — a. radialis, a. ulnaris, at the same time pulse on humeral and popliteal arteries normal is defined.

At patients consecutive infections of skin and hypodermic cellulose in distal departments of extremities are quite often observed.
The illness quickly enough progresses and is characterized by frequent aggravations which are quite often provoked by influence of cold or intensive smoking. Pains at rest, ulcers and gangrene can develop from several months to several years in time — considering from the first displays of a disease.

Treatment of an obliterating thromboangitis

Treatment of an obliterating thromboangitis first of all consists in refusal of smoking. As well as at atherosclerosis of arteries of the lower extremities, recommend the dosed walking for the purpose of development of collaterals, reception of trental on 300 mg 3 times a day, aspirin on 0,1 g/days. There are messages on a favorable effect of antagonists of calcium.

The sympathectomy in some cases allows to reduce pains and other manifestations of a vasospasm. Revascularization is inapplicable as there is a multiple defeat of small vessels.
It is reported also about positive action of a plasma exchange and hyperbaric oxygenation, but these methods are not standard.

At emergence of necroses amputation of the affected fingers of hands (at the correct maintaining patients it, fortunately, is required not often) is carried out; at gangrene of fingers of foot or the foot economical (low) amputation — usually on border of nekrotizirovanny fabrics is carried out. At patients with manifestation of consecutive infection antibiotics are appointed.
The forecast at the patients who stopped smoking and not having frequent aggravations, rather favorable. At the patients continuing to smoke with frequent exacerbations of a disease — the forecast concerning preservation of foot is much worse.

 
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