Pregnancy complicated with Buerger's disease

Cureus

Thromboangitis obliterans or Buerger's disease is a segmental inflammatory condition of small and medium-sized arteries and veins. It is commonly seen in males with age under 45 years and with a current or recent history of tobacco use, and in smokers. It is sporadic in young women. This report describes a primigravida with dry gangrene in both upper and lower limbs because of Buerger's disease. The primary diagnosis of the disease occurred first time in pregnancy at the 17th week of gestation with the patient reporting dry gangrene and pain in the digits and confirmed with a non-invasive Doppler study. The patient was screened for autoimmune diseases, diabetes mellitus, and the presence of hypercoagulable disorders. Echocardiography and arteriography were performed to rule out any source of emboli. The case report aims to discuss a rare diagnostic and therapeutic dilemma in the case of a pregnant woman presenting with gangrene without any history of tobacco addiction.

Beyond Rheumatology, 2019

Buerger's disease, or thromboangiitis obliterans (TAO), is a segmental non-atherosclerotic occlusive inflammatory condition of small arteries and veins of the upper and lower extremities, characterized by thrombosis and recanalization of the affected vessels. It is triggered by substantial exposure to tobacco, especially in males aged from 20 to 50. Currently, the most effective treatment, together with the suspension of the smoking habit, is represented by prostacyclin infusion (Iloprost). We described two cases of Buerger's disease recently presented to our observation, with some different clinical features and therapeutic pathways.

Seminars in Vascular Surgery, 2003

Buerger's disease (thromboangiitis obliterans or TAO) is a clinical syndrome characterized by the development of segmental thrombotic occlusions of the medium and small arteries of the extremities. It is clinically and pathologically distinguishable from arteriosclerosis and necrotizing arteritis. Afflicted patients are mostly young, male, inveterate tobacco smokers who present with distal extremity ischemia, ischemic ulcers, or frank gangrene of the toes or fingers. Large arteries are typically spared, as are the coronary, cerebral, and visceral circulations. While mortality is not increased, patients with Buerger's disease often suffer from severe ischemic pain and tissue loss culminating in minor and major limb amputation. Clinical diagnostic criteria generally include the following: (1) history of smoking or tobacco abuse; (2) age of onset less than 45 to 50 years; (3) infrapopliteal, segmental arterial occlusions with sparing of the proximal vasculature; (4) frequent distal upper extremity arterial involvement (Raynaud's syndrome or digital ulceration); (5) superficial phlebitis; and (6) exclusion of arteriosclerosis, diabetes, true arteritis, proximal embolic source, and hypercoagulable states. Typical arteriographic patterns have been described that are suggestive, but not pathognomonic. While the cause of Buerger's disease remains unknown, the disease onset and clinical course are inextricably linked to tobacco abuse. Acute Buerger's disease is characterized histopathologically by intensely cellular vessel wall inflammation, giant cell foci, and hypercellular thrombi, but with preservation of the elastic lamina and the overall vascular wall architecture. Most investigators feel that Buerger's disease is an immune-mediated endarteritis; recent immunocytochemical studies have identified the linear deposition of immunoglobulins and complement factors along the elastic lamina. The inciting antigen has not been discovered. Tobacco abstinence generally results in disease quiescence and remains the mainstay of treatment.

The Journal of Maternal-Fetal & Neonatal Medicine, 2009

Objective. We have studied 37 women with all forms of cerebrovascular diseases. Our aim was to study the etiology, clinical manifestations and prognosis of such conditions during pregnancy or puerperium. Methods. We analyzed the most common causes of cerebrovascular diseases during the given period. Results. The most common causes of cerebrovascular diseases during pregnancy or puerperium are hematological coagulation disorders, cardio embolism and eclampsia, whereas other causes ara rarer. Conclusions. The incidence of cerebrovascular diseases during pregnancy or puerperium is 11%. Cerebrovascular diseases are more frequent in puerperium than during pregnancy, being 1.8:1. Etiology remains undetermined in 35% of the cases.

The American Journal of Surgery, 1987

In an effort to determine the current incidence and clinical course of Buerger's disease, we reviewed the records of over 700 patients with small artery disease who were evaluated at Oregon Health Sciences University during a 15 year period. We identified 26 patients who met rigid criteria for the diagnosis of Buerger's disease. An analysis of the management and extended follow-up of these patients has indicated that Buerger's disease, although rare, is a real clinical entity which can be diagnosed objectively. The relatively high rate of limb loss (31 percent of patients) documents the virulence of Buerger's disease involving the lower extremities. No major upper extremity amputations were required, and no patient lost further tissue after cessation of smoking. These findings and the low mortality rate in this study stand in contrast to many previous reports and may aid in establishing the current natural history of Buerger's disease in North America.

PubMed, 2012

Gestation is a period of significant physiological changes that can severely affect the function of many systems, including the cardiovascular. The deviation from the standard that occurs during pregnancy may cause the deterioration of pre-existent cardiovascular diseases or the appearance of new ones. In this review we will present the most common congenital and acquired cardiovascular diseases, their clinical expression and therapeutic procedures according to the latest international guidelines.

Stroke Research and Treatment, 2011

Ischemic stroke during pregnancy and puerperium represents a rare occurrence but it could be a serious and stressful event for mothers, infants, and also families. Whenever it does occur, many concerns arise about the safety of the mother and the fetus in relation to common diagnostic tests and therapies leading to a more conservative approach. The physiological adaptations in the cardiovascular system and in the coagulability that accompany the pregnant state, which are more significant around delivery and in the postpartum period, likely contribute to increasing the risk of an ischemic stroke. Most of the causes of an ischemic stroke in the young may also occur in pregnant patients. Despite this, there are specific conditions related to pregnancy which may be considered when assessing this particular group of patients such as pre-eclampsia-eclampsia, choriocarcinoma, peripartum cardiomiopathy, amniotic fluid embolization, and postpartum cerebral angiopathy. This article will consi...

BIRDEM Medical Journal, 2016

Buerger's disease or Thromboangiitis obliterans is a segmental inflammatory disease that affects the vessels and nerves of the extremities. It usually affects men below 45 years old and correlates with tobacco, as a predisposing factor. A young adolescent boy of 18 yrs, smoker, nonalcoholic, nondiabetic was presented with the complaints of progressive aching pain (Claudication pain) during walking in both legs which relives by taking rest for last 3 years and also suffering from long standing non healing ulcer in the right great toe and second toe following traumatic nail avulsion.

Canadian Journal of General Internal Medicine

The American College of Chest Physicians (ACCP) published its latest (9th edition) guidelines in February 2012. This document is a valuable reference for all clinicians. In the current article, through the analysis of three clinical cases, the authors review, describe, and analyze the most significant new information from the chapter “VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy”: (1) strategies for clinicians facing the prescription of a new drug during pregnancy with little available data; (2) recommendations about indications of thromboprophylaxis for asymptomatic thrombophilias; and (3) thrombophilia screening and secondary prevention for placental complications.

Rheumatology, 2007

Thromboangiitis obliterans (Buerger's disease)-a type of vasculitis in young, mostly male subjects-remains strangely linked to smoking, which determines its occurrence, progression and prognosis by currently unknown mechanisms. It affects the small and medium-sized arteries and veins of the limbs. Despite the usual absence of systemic signs and symptoms, initially intermittent arthritis, even if not observed in all cases, confer on this disease the status of a systemic vasculitis. Diagnosis requires the elimination of many other diseases. The severity of the disease lies in the need for amputation in more than a quarter of all patients. Complete cessation of smoking remains the cornerstone of therapy. Local care is the second essential element of treatment. Prostacycline analogues can be used to help the patient through critical ischaemia. Blockade with antagonists of cannabinoid or endothelin receptors and the use of gene-or cell-based therapy to induce therapeutic angiogenesis have opened up new possibilities for treatment.