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Buerger’s disease: providing integrated care

Authors Klein-Weigel P, Volz TS, Zange L, Richter J

Received 6 April 2016

Accepted for publication 27 May 2016

Published 12 October 2016 Volume 2016:9 Pages 511—518

DOI https://doi.org/10.2147/JMDH.S109985

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Peter Klein-Weigel,1 Theresa Sophie Volz,1 Leonora Zange,2 Jutta Richter,3

1Clinic of Angiology, 2Clinic of Cardiology and Nephrology, HELIOS Klinikum Berlin-Buch, Berlin, 3Medical Faculty, Department of Rheumatology and Hiller Research Unit Rheumatology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany

Abstract: Buerger’s disease, also known as thromboangiitis obliterans (TAO), is a segmental inflammatory disease affecting small- and medium-sized vessels, which is strongly associated with tobacco use. Although the etiology is still unknown, recent studies suggest an immunopathogenesis. Diagnosis is based on clinical and angiomorphologic criteria, including age, history of smoking, clinical presentation with distal extremity ischemia, and the absence of other risk factors for atherosclerosis, autoimmune disease, hypercoagulable states, or embolic disease. Until now, no causative therapy exists for TAO. The most important therapeutic intervention is smoking cessations and intravenous prostanoid infusions (iloprost). Furthermore, effective analgesia is crucial for the treatment of ischemic and neuropathic pain and might be expanded by spinal cord stimulation. Revascularization procedures do not play a major role in the treatment of TAO due to the distal localization of arterial occlusion. More recently, immunoadsorption has been introduced eliminating vasoconstrictive G-protein-coupled receptor and other autoantibodies. Cell-based therapies and treatment with bosentan were also advocated. Finally, a consequent prevention and treatment of wounds and infections are essential for the prevention of amputations. To achieve better clinical results, integrated care in multidisciplinary and trans-sectoral teams with emphasis on smoking cessation, pain control, wound management, and social care by professionals, social workers, and family members is necessary.

Keywords: Winiwater-Buerger's disease, Winiwarter–Buerger, thromboangiitis obliterans, immunoadsorption

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