Jorge Vanda Cristina, Araújo Ana Carolina, Noronha Carla, Panarra António, Riso Nuno, Vaz Riscado Manuel
Department 2, Curry Cabral's Hospital, Lisbon, Portugal.
BMJ Case Rep. 2011 Sep 13;2011:bcr0820114621. doi: 10.1136/bcr.08.2011.4621.
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. The authors present the case of a 34-year-old male, with ulcers in the fingertips with progressive worsening: acrocyanosis, slow healing, necrosis and finally loss of substance. Dorsalis pedis and posterior tibial pulses were not palpable. Personal history of heavy smoking was (20 pack-years). The angiography revealed proximal occlusion of the left posterior tibial and interosseal arteries, with distal circulation by the anterior tibial artery. He was submitted to disarticulation of the second left toe and therapy with pentoxifyline and iloprost infusion, calcium antagonist, antiplatelet drugs, statin and low molecular weight heparin (later replaced by oral anticoagulation). Improvement was seen of active vascular lesions and pain symptoms.
血栓闭塞性脉管炎是一种节段性炎症性疾病，累及四肢血管和神经。该病通常影响45岁以下男性，且与吸烟这一诱发因素相关。作者报告了一例34岁男性病例，其指尖出现溃疡并逐渐加重，表现为手足发绀、愈合缓慢、坏死，最终组织缺失。足背动脉和胫后动脉搏动未触及。有重度吸烟个人史（20包年）。血管造影显示左胫后动脉和骨间动脉近端闭塞，通过胫前动脉有远端循环。患者接受了左足第二趾离断术，并接受己酮可可碱和伊洛前列素输注、钙拮抗剂、抗血小板药物、他汀类药物及低分子量肝素治疗（后改为口服抗凝治疗）。可见活动性血管病变和疼痛症状有所改善。
