Stvrtinova V, Ambrozy E, Stvrtina S, Lesny P
2nd Clinic of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
Bratisl Lek Listy. 1999 Mar;100(3):123-8.
Thromboangiitis obliterans or Winiwarter-Buerger's disease is a primary systemic vasculitis of an unknown etiology, which affects medium-sized arteries and veins mainly in the lower and upper extremities, causing multiple segmental arterial occlusions especially in young male smokers. The aim of our study is to compare the knowledge on the etiology, epidemiology, clinical presentation, diagnostic and therapeutic possibilities in the time of Leo Buerger (90 years ago) and now. Between 1994 and 1998, 26 patients (19 men and 7 women) were investigated with clinical suspicion for Winiwarter-Buerger's disease. Laboratory and arteriographic investigation revealed typical signs for this disease in 22 of them. To the most common clinical signs or symptoms belong smoking and the onset of the disease before the age of 50 years (in 95.5%), intermittent claudication (in 72.7%), rest pain and ischaemic ulcers or gangrenes in the fingers (in 68.2%). In slightly more than half of the patients migrating superficial thrombophlebitis was present and similarly in one half of the patients Raynaud's phenomenon was found. In conclusion--What has changed from the times of Leo Buerger? 1. Prevalence of TAO increased in women. 2. Older patients (more than 40 years old) are being diagnosed. 3. Upperextremity involvement is more frequently present. 4. Diagnosis of TAO is being more proper, especially due to up-to-date diagnostic methods, like digital subtraction angiography. 5. The treatment is more effective, amputation number is decreased. And what has not changed? Similarly like Leo Buerger we do not known the precise etiology of the disease. Ceasation of smoking has still the most important therapeutic procedure. The clinical course of the disease is individual and in spite of the treatment is the clinical course unpredictable. (Tab. 5, Ref. 47.)
血栓闭塞性脉管炎或温尼瓦特-伯格氏病是一种病因不明的原发性系统性血管炎，主要累及上下肢的中动脉和静脉，导致多发节段性动脉闭塞，尤其在年轻男性吸烟者中更为常见。我们研究的目的是比较在利奥·伯格时代（90年前）和现在，关于病因、流行病学、临床表现、诊断和治疗可能性的认识。1994年至1998年间，对26例临床怀疑患有温尼瓦特-伯格氏病的患者（19名男性和7名女性）进行了调查。实验室检查和动脉造影检查发现其中22例有该病的典型体征。最常见的临床体征或症状包括吸烟以及50岁之前发病（95.5%）、间歇性跛行（72.7%）、静息痛以及手指缺血性溃疡或坏疽（68.2%）。略超过半数的患者存在游走性浅静脉炎，同样有半数患者发现有雷诺现象。总之——自利奥·伯格时代以来有哪些变化？1. 血栓闭塞性脉管炎在女性中的患病率增加。2. 诊断出的老年患者（40岁以上）增多。3. 上肢受累更为常见。4. 血栓闭塞性脉管炎的诊断更加准确，尤其是由于采用了数字减影血管造影等最新诊断方法。5. 治疗更有效，截肢数量减少。那又有哪些没有改变呢？和利奥·伯格时代一样，我们仍不清楚该病的确切病因。戒烟仍然是最重要的治疗措施。疾病的临床过程因人而异，尽管进行了治疗，临床过程仍不可预测。（表5，参考文献47）
