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Fazeli B, Poredos P, Kozak M, Pecsvarady Z, Catalano M, Al Salman MM, Altarazi L, Ali AA, Bashar AH, Bozkurt K, Cacione D, Chua B, Cvjetko I, Desai S, Erer D, Farkas K, Gaddikeri P, Geroulakos G, Guclu O, Hussein E, Ionac M, Iwai T, Karahan O, Kashani D, Kota A, Kroger K, Kubat E, Kumar PP, Lang W, Lobastov K, Malecki R, Marcoccia A, Ozbakkaloglu A, Pandey SR, Patel M, Polat A, Rajeev A, Ravari H, Samuel V, Schernthaner G, Selvaraj D, Sanri US, Sermsathanasawadi N, Sharebiani H, Stanek A, Stephen E, Szuba A, Taha W, Taheri H, Wautrecht JC, Yuwono HS, Zor MH, Liew A. Diagnostic criteria for Buerger's disease: International Consensus of VAS - European Independent Foundation in Angiology/Vascular Medicine. INT ANGIOL 2023; 42:396-401. [PMID: 38010012 DOI: 10.23736/s0392-9590.23.05098-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Buerger's disease (BD) remains a debilitating condition and early diagnosis is paramount for its effective management. Despite many published diagnostic criteria for BD, selective criteria have been utilized in different vascular centers to manage patients with BD worldwide. A recent international Delphi Consensus Study on the diagnostic criteria of BD showed that none of these published diagnostic criteria have been universally accepted as a gold standard. Apart from the presence of smoking, these published diagnostic criteria have distinct differences between them, rendering the direct comparison of patient outcomes difficult. Hence, the expert committees from the Working Group of the VAS-European Independent Foundation in Angiology/Vascular Medicine critically reviewed the findings from the Delphi study and provided practical recommendations on the diagnostic criteria for BD, facilitating its universal use. We recommend that the 'definitive' diagnosis of BD must require the presence of three features (history of smoking, typical angiographic features and typical histopathological features) and the use of a combination of major and minor criteria for the 'suspected' diagnosis of BD. The major criterion is the history of active tobacco smoking. The five minor criteria are disease onset at age less than 45 years, ischemic involvement of the lower limbs, ischemic involvement of one or both of the upper limbs, thrombophlebitis migrans and red-blue shade of purple discoloration on edematous toes or fingers. We recommend that a 'suspected' diagnosis of BD is confirmed in the presence of a major criterion plus four or more minor criteria. In the absence of the major criterion or in cases of fewer than four minor criteria, imaging and laboratory data could facilitate the diagnosis. Validation studies on the use of these major and minor criteria are underway.
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Affiliation(s)
- Bahare Fazeli
- Support Association of Patients of Buerger's Disease (Buerger's Disease NGO), Mashhad, Iran
| | - Pavel Poredos
- Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Matija Kozak
- Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Zsolt Pecsvarady
- Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary
| | - Mariella Catalano
- Inter-University Research Center on Vascular Disease, Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | | | - Louay Altarazi
- Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria
| | - Abrar A Ali
- South Surgical Department, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Abul H Bashar
- Department of Vascular Surgery, National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh
| | - Kursat Bozkurt
- Department of Cardiovascular Surgery, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Türkiye
| | - Daniel Cacione
- Unit of Vascular and Endovascular Surgery, Department of Surgery, Federal University of Sao Paulo (UNIFESP/EPM), Sao Paulo, Brazil
| | - Benjamin Chua
- Vascular and Interventional Center of Singapore, Novena Specialist Center, Singapore, Singapore
| | - Ivan Cvjetko
- Department of Vascular Surgery, Merkur University Hospital, Zagreb, Croatia
| | - Sanjay Desai
- Department of Vascular and Endovascular Surgery, Ramaiah Medical College Hospital, Bangalore, India
| | | | - Katalin Farkas
- Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary
| | | | - Georgios Geroulakos
- Department of Vascular Surgery, National and Kapodestrian University, Athens, Greece
| | - Orkut Guclu
- Department of Cardiovascular Surgery, Medical School of Trakya University, Edirne, Türkiye
| | - Emad Hussein
- Department of Vascular Surgery, Ain Shams University, Cairo, Egypt
| | - Mihai Ionac
- Department of Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Oguz Karahan
- Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya, Türkiye
| | - Daniel Kashani
- Division of Hospital Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Albert Kota
- Vascular Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Knut Kroger
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Emre Kubat
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Prabhu P Kumar
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Werner Lang
- Department of Vascular Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Kirill Lobastov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Rafal Malecki
- Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Antonella Marcoccia
- Angiology and Autoimmunity Medical Unit, Rare Diseases Reference Center for Systemic Sclerosis, Sandro Pertini Hospital, Rome, Italy
| | - Alper Ozbakkaloglu
- Department of Cardiovascular Surgery, Özel Sağlık Hastanesi, İzmir, Türkiye
| | - Sandeep R Pandey
- Department of Vascular and Endovascular Surgery, Annapurna Hospital, Kathmandu, Nepal
| | - Malay Patel
- Department of Vascular Surgery, Apollo-CVHF Hospital, Ahmedabad, India
| | - Adil Polat
- Department of Cardiovascular Surgery, University of Health Sciences, İstanbul Bagcilar Research and Training Hospital, Istanbul, Türkiye
| | | | - Hassan Ravari
- Vascular Surgery Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vimalin Samuel
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Gerit Schernthaner
- Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
| | - Dheepak Selvaraj
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Umut S Sanri
- Department of Cardiovascular Surgery, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Türkiye
| | - Nuttawut Sermsathanasawadi
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hiva Sharebiani
- Support Association of Patients of Buerger's Disease (Buerger's Disease NGO), Mashhad, Iran
| | - Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland
| | - Edwin Stephen
- Department of Vascular Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Andrzej Szuba
- Department of Angiology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Wassila Taha
- Non Invasive Vascular Lab, Al Salam Hospital, Cairo, Egypt
| | - Hossein Taheri
- Department of General Surgery, Farabi Hospital, Mashhad, Iran
| | - Jean-Claude Wautrecht
- Service of Vascular Pathology, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - Hendro S Yuwono
- Department of Vascular Surgery, School of Medicine, Islamic University of Bandung, Bandung, Indonesia
| | - Mustafa H Zor
- Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Ankara, Türkiye
| | - Aaron Liew
- University of Galway & Portiuncula University Hospital, Saolta University Health Care, Galway, Ireland -
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Modaghegh MHS, Kamyar MM, Shafiei A, Shariatmaghani SS, Saremi E, Sadeghipour Kermani F. A comprehensive review of the epidemiology and clinical features of 91 cases with Buerger's disease. Vascular 2023:17085381231175257. [PMID: 37172074 DOI: 10.1177/17085381231175257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Thromboangiitis Obliterans (TAO) is a disease of small and medium-sized arteries with an unclear natural course. This study aims to establish a national registry of the disease to gain a better understanding of its epidemiology and clinical course. METHOD This study was a cohort study of 242 patients with a high probability of TAO admitted to Mashhad University of Medical Sciences (MUMS) hospitals from 2000 to 2015. Of these, 91 patients with a confirmed diagnosis were included in the study (90 males and 1 female) with a mean age of 35 ± 7.8 years. RESULTS The most common symptom upon onset of the disease was paresthesia (29.7%), followed by cold sensitivity and paresthesia (93.4%) during the progression of the disease and Raynaud syndrome or vasospasm (93.9%) in the active phase. The right lower limb was the most commonly affected limb (46.2%), and presenting ischemic symptoms in 48.4%.Statistics indicated a positive correlation between the duration of Burger's disease and the number of affected limbs (p = 0.001). There was no effect of disease duration on the likelihood of amputations (p = 0.28). CONCLUSION Some patients may experience mild, subtle symptoms for years before the initial signs and symptoms appear, which can be severe and rapidly progress to the point of requiring amputation.We suggest that the diagnostic criteria for Buerger's disease should be revised in light of the presence of atherosclerosis and its associated risk factors, which present a challenge in terms of diagnosis and treatment. Clinical experience will be of great importance in this regard.
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Affiliation(s)
- Mohammad Hadi Saeed Modaghegh
- Professor of Vascular Surgery, Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Mahdi Kamyar
- Assistant Professor of Vascular Surgery, Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Shafiei
- Assistant Professor of Vascular Surgery, Qom University of Medical Sciences, Qom, Iran
| | - Somayeh Sadat Shariatmaghani
- Assistant Professor of Internal Medicine, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elena Saremi
- Vascular Surgeon, Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Sadeghipour Kermani
- Community and Preventive Medicine, Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Science, Mashhad, Iran
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Chung MH, Lee JS, Kang JS. Buerger's Disease May be a Chronic Rickettsial Infection with Superimposed Thrombosis: Literature Review and Efficacy of Doxycycline in Three Patients. Infect Chemother 2022; 54:20-58. [PMID: 35384418 PMCID: PMC8987189 DOI: 10.3947/ic.2021.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/26/2022] [Indexed: 12/03/2022] Open
Abstract
Buerger's disease (BD) is a chronic inflammatory vasculitis of unknown etiology. The infectious etiology of BD was proposed by Buerger in 1914. Furthermore, there are scattered reports insisting that BD may be related to rickettsial infection, first asserted by Goodman since 1916, followed by Giroud and other French investigators from the 1940s through the 1960s, Nicolau in the 1960s, Bartolo (1980s), and Fazeli (2010s). However, their causal relationship has hardly been accepted because rickettsial infections are known to be acute febrile, vector-borne illnesses, whereas BD is a chronic afebrile illness. In this article we review the relevant literature on the chronic nature of Rickettsia and Orientia infections and on the rickettsial etiology of BD. Excellent initial responses to doxycycline in three patients with BD are briefly described. Based on these findings, we hypothesize that BD patients acquired a rickettsial infection far before the onset of BD. Over years, the infected area expands to become a segment of the infected vessel. Subsequently, thrombus develops on the luminal surface of the infected endothelial cells, which produces the vascular obstructive manifestations of BD. Collectively, it is postulated that BD is a chronic infection with a member of the family Rickettsiaceae with superimposed thrombosis.
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Affiliation(s)
- Moon-Hyun Chung
- Division of Infectious Diseases, Department of Internal Medicine, Seogwipo Medical Center, Jeju, Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University, Incheon, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University, Incheon, Korea.
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Fazeli B, Poredos P, Patel M, Klein-Weigel P, Catalano M, Stephen E, Al Salman MM, Altarazi L, Bashar AH, Chua B, Colgan MP, Cvjetko I, Desai S, Dimakakos EP, Erer D, Farkas K, Fowkes GR, Gerotziafas G, Hussein E, Ionac M, Iwai T, Karahan O, Kolossvary E, Kota A, Kozak M, Kroger K, Kumar PP, Liew A, Malecki R, Najafi MH, Olinic DM, Pandey SR, Pecsvarady Z, Ravari H, Samuel V, Schernthaner G, Selvaraj D, Sermsathanasawadi N, Sharebiani H, Stanek A, Szuba A, Taheri H, Wautrecht JC, Hakan Zor M. Milestones in thromboangiitis obliterans. A position paper of the VAS-European Independent Foundation in Angiology/Vascular Medicine. INT ANGIOL 2021; 40:395-408. [PMID: 34236154 DOI: 10.23736/s0392-9590.21.04712-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Unfortunately, even today Thromboangiitis Obliterans has disease features that remain misunderstood or underappreciated. The epidemiology, etiology and pathophysiology of the disease are still unclear. Biomarkers and disease activity markers are lacking, thus clinical assessment is difficult. We are still struggling to establish unique diagnostic, staging and treatment criteria. This is an academic-collaborative effort to describe the pathophysiology, the clinical manifestations, the diagnostic approach, and the challenges of management of patients with TAO. METHODS A systematic search for relevant studies dating from 1900 to the end of 2020 was performed on the PubMed, SCOPUS, and Science Direct databases. RESULTS Given the intriguing nature of presentation of TAO, its management, to some extent is not only different in different regions of the world but also varies within the same region. Following this project, we discovered ambiguity, overlap and lack of clear-cut criteria for management of TAO. CONCLUSIONS AND RELEVANCE An international group of experts however came to one conclusion. They all agree that management of TAO is in need of a call for action for a renewed global look with multi-center studies, to update the geographical distribution of the disease and to establish a unique set of diagnostic criteria and a consensus-based guideline for best treatment based on current evidence.
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Affiliation(s)
- Bahare Fazeli
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pavel Poredos
- Medical Association of Slovenia and SMA, Slovenia Academic Research Centre, Slovenian Medical Academy, Ljubljana, Slovenia -
| | - Malay Patel
- Vascular Surgery Department, Apollo CVHF Hospital, Ahmedabad, India
| | - Peter Klein-Weigel
- Klinik für Angiologie, Zentrum für Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany
| | - Mariella Catalano
- Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy
| | - Edwin Stephen
- Vascular Surgery Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mussaad M Al Salman
- Division of Vascular Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Louay Altarazi
- Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria
| | - Abul H Bashar
- National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh
| | - Benjamin Chua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ivan Cvjetko
- James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - Sanjay Desai
- Department of Vascular Surgery, University Hospital Mekur, Zagreb, Croatia
| | - Evangelos P Dimakakos
- Department of vascular and endovascular surgery, Ramaiah Medical College Hospital, Bangalore, India
| | - Dilek Erer
- Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katalin Farkas
- Gazi university, Faculty of Medicine, Department of cardiovascular surgery, Ankara, Turkey
| | | | | | - Emad Hussein
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Mihai Ionac
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
| | - Takehisa Iwai
- Vascular surgery department, Ain Shams University, Cairo, Egypt
| | - Oguz Karahan
- Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu 2, Timisoara, Romania
| | - Endre Kolossvary
- Gazi university, Faculty of Medicine, Department of cardiovascular surgery, Ankara, Turkey
| | - Albert Kota
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Matija Kozak
- Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya/Antalya, Turkey
| | - Knut Kroger
- Department of Vascular Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prabhu P Kumar
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Aaron Liew
- Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Rafal Malecki
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Mohammad H Najafi
- Portiuncula University Hospital, Soalta University Health Care Group, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Dan M Olinic
- Department of Angiology, Systemic hypertension and diabetology
| | | | | | - Hasan Ravari
- Department of Cardiology, Tehran Medical Unit, Azad University, Tehran, Iran
| | - Vimalin Samuel
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Gerit Schernthaner
- Medical Clinic No 1, University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Dheepak Selvaraj
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | | | - Hiva Sharebiani
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Agata Stanek
- Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary
| | - Andrzej Szuba
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Hossein Taheri
- Vascular Surgery Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jean Claude Wautrecht
- Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
| | - Mustafa Hakan Zor
- Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Soudet S, Le Joncour A, Quemeneur T, Maillard H, Koskas F, Hachulla E, Cacoub P, Yelnik CM, Saadoun D, Lambert M. Did the Clinical Spectrum of Thromboangiitis Obliterans Change in the Past 40 Years? Angiology 2020; 71:621-625. [PMID: 32319306 DOI: 10.1177/0003319720920163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thromboangiitis obliterans (TAO) is an inflammatory disease that usually affects small and medium-sized arteries in the upper and lower limbs of young smokers. Previous studies showed that the spectrum TAO has changed in the 80s: the male-to-female ratio decreased, older patients were diagnosed, and upper limb involvement was more common. The aim of our study was to assess the changing clinical spectrum of TAO in France during the past 40 years. All consecutive patients fulfilling TAO's criteria between January 1967 and January 2016 were retrospectively included in 3 departments of internal medicine. We compared TAO features in patients diagnosed before and after 2002; 141 (77.5%) men and 41 (22.5%) women were included. Patients diagnosed after 2002 were older (37 [31-39] vs 34 [29-35] years P = .03), had a more frequent isolated upper limb involvement (34.3% vs 7.8% P = .001), and less frequent isolated lower limb involvement (55.7% vs 74.5%, P < .001). The clinical spectrum of TAO has changed in France since the beginning of the 21st century.
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Affiliation(s)
- Simon Soudet
- Department of Internal Medicine, Hôpital HURIEZ, CHRU Lille, France
| | - Alexandre Le Joncour
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, des Maladies Auto-Inflammatoires et de l'Amylose, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR 7211, France
| | - Thomas Quemeneur
- Department of Nephrology and Internal Medicine, Valenciennes Hospital, France
| | - Helene Maillard
- Department of Internal Medicine, Hôpital HURIEZ, CHRU Lille, France
| | - Fabien Koskas
- Department of Vascular Surgery, Assistance Publique des Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Paris, France
| | - Eric Hachulla
- Department of Internal Medicine, Hôpital HURIEZ, CHRU Lille, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, des Maladies Auto-Inflammatoires et de l'Amylose, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR 7211, France
| | - Cecile M Yelnik
- Department of Internal Medicine, Hôpital HURIEZ, CHRU Lille, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, des Maladies Auto-Inflammatoires et de l'Amylose, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR 7211, France
| | - Marc Lambert
- Department of Internal Medicine, Hôpital HURIEZ, CHRU Lille, France
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Ehteshamfar SM, Afshari JT, Modaghegh MHS, Mahmoudi M, Kazemzadeh GH, Kermani FS. Humoral and cellular immune response to Buerger's disease. Vascular 2020; 28:457-464. [PMID: 32212917 DOI: 10.1177/1708538120910055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Thromboangiitis obliterans is a nonatherosclerotic occlusive disease, affecting small to moderate sized arteries of the upper and lower extremities, leading to progressive inflammation and clot formation. However, the role of humoral and cell-mediated immunity in the development of this disease has not been clearly identified. The present study was intended to investigate the humoral and cellular immune response in patients with Buerger's disease with different disease severity. METHODS In an observational study, 80 male patients with Buerger's disease were included and categorized into three groups (mild, moderate, and severe) based on clinical manifestations. After blood sampling, cellular phenotypes were determined, and erythrocyte sedimentation rate, immunoglobulins (Ig) A, M, G, and E, as well as C3 and C4 components of the complement system and complement hemolytic activity (CH50) were measured. RESULTS The mean age of the patient was 42.85 ± 8.39 years. Pulse abnormality, cold intolerance, and claudication were the most common symptoms. Eleven (13.75%), 46 (57.50%), and 23 (28.75%) patients had mild, moderate, and severe symptoms. Regression analyses showed that the presence of severe symptoms was significantly associated with elevated erythrocyte sedimentation rate and C4 levels (p < 0.05). CONCLUSION Buerger's disease in severe cases was associated with increased erythrocyte sedimentation rate and abnormal C4 levels. The alterations in these inflammatory biomarkers might be due to a secondary inflammatory response to the presence of ulcer or gangrene and the inflammatory process in patients with severe symptoms.
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Affiliation(s)
| | - Jalil Tavakkol Afshari
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad-Hadi S Modaghegh
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Mahmoudi
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gholam Hosein Kazemzadeh
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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7
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Firat A, Igus B. Endovascular Recanalization of Thromboangiitis Obliterans (Buerger’s Disease) in Twenty-Eight Consecutive Patients and Combined Antegrade–Retrograde Intervention in Eight Patients. Cardiovasc Intervent Radiol 2019; 42:820-828. [DOI: 10.1007/s00270-019-02193-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/21/2019] [Indexed: 12/24/2022]
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9
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Rivera-Chavarría IJ, Brenes-Gutiérrez JD. Thromboangiitis obliterans (Buerger's disease). Ann Med Surg (Lond) 2016; 7:79-82. [PMID: 27144003 PMCID: PMC4840397 DOI: 10.1016/j.amsu.2016.03.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/21/2016] [Accepted: 03/25/2016] [Indexed: 12/18/2022] Open
Abstract
Thromboangiitis Obliterans is a non-atherosclerotic inflammatory disease of unknown etiology, which has a strong association with tobacco. We present current concepts on the pathophysiology and diagnosis, as well as a review in treatments. Current concepts on the pathophysiology and diagnosis of Thromboangiitis Obliterans. Importance of complete abstinence of tobacco. Actual Treatments of Thromboangiitis Obliterans.
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Affiliation(s)
- Ignacio J Rivera-Chavarría
- Division of Vascular Surgery, Rafael Ángel Calderón Guardia Hospital, Caja Costarricense del Seguro Social, San José, Costa Rica
| | - José D Brenes-Gutiérrez
- Division of Vascular Surgery, Rafael Ángel Calderón Guardia Hospital, Caja Costarricense del Seguro Social, San José, Costa Rica
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Ratbi MI, Abissegue GY, Tarchouli M, Tajedine MT. [Severe mesenteric infarction by superior mesenteric artery occlusion in a patient suffering from Buerger's disease]. Pan Afr Med J 2014; 19:322. [PMID: 25918562 PMCID: PMC4404508 DOI: 10.11604/pamj.2014.19.322.5718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 11/18/2014] [Indexed: 11/11/2022] Open
Abstract
La thromboangéite oblitérant ou maladie de Buerger, est une artérite inflammatoire non-artériosclérotique touchant classiquement les réseaux vasculaires périphériques des membres. Elle atteint principalement les hommes jeunes tabagiques et sans autres facteurs de risques cardiovasculaires. Les atteintes des artères digestives sont très rares et souvent fatales si elles ne sont pas évoquées et prises en charge précocement. Nous rapportons l'observation d'un jeune patient tabagique chronique qui s’était présenté aux urgences dans un tableau de péritonite aigue négligée due a un infarctus entero-mésentérique massif. L'origine était une ischémie mésentérique due à une thrombose de l'artère mésentérique supérieure. L’étude anatomopathologique avait objectivée une atteinte des artères digestive due à la maladie de Buerger.
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Affiliation(s)
- Moulay Ibrahim Ratbi
- Service de Chirurgie Viscérale, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | | | - Mohamed Tarchouli
- Service de Chirurgie Viscérale, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
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Abstract
Thromboangiitis obliterans, or Buerger disease, is a debilitating vascular disease with a well-known pronounced link to cigarette smoking and, more specifically, to the nicotine component of tobacco inhalation. Buerger disease is an inflammatory occlusive disorder that primarily affects the medium and small vessels of the extremities. In the present case report, a 46-year-old man, nonforthcoming smoker, presented to the authors' clinic with a deep ulcer at the head of the second metatarsal. Evidently, although the patient continued to smoke, the ulcer responded to therapy but regressed. Once the history was elaborated, the patient stopped smoking, and the ulcer healed completely within 2 months. Follow-up appointments proved to be unremarkable and to the authors' knowledge, there has not been a reoccurrence, and the patient remains tobacco-free.
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Koh YB. Buerger’s Disease; Any Current Advances? Ann Vasc Dis 2008. [DOI: 10.3400/avd.edit00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Boari B, Salmi R, Manfredini R. Buerger's disease: Spinal cord stimulation may represent a useful tool for delaying amputation in young patients. Eur J Intern Med 2007; 18:259. [PMID: 17449407 DOI: 10.1016/j.ejim.2006.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 09/28/2006] [Indexed: 11/24/2022]
Affiliation(s)
- Benedetta Boari
- Department of Internal Medicine, General Hospital of Ferrara, Italy
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