Dr Cacovean Adrian

Thrombangeitis obliterans (Winiwarter-Burger's disease)

This disease is for people without medical training, patients and persons interested to learn some important data about the disease they have reached on this page of the website.

The definition of the disease is arising from the findings of the pathologoanatomic examination (biopsy or autopsy) and they are:

• Thrombus = clot;
• Angios = vessel (blood);
• Itis = inflammation (as in tonsillitis, pharyngitis, appendicitis).

- Thrombangeitis
- What is that? From the definition and exactly as in reality: a disease of blood vessels when arteries are looked at under a microscope (autopsy examination of the patient deceased and pathologoanatomic examination of the member amputated), we find that they (the arteries) are filled with clots, have thickened and inflamed walls. Everyone knows of arteritis and its consequences, usually thigh amputations in reality there are several kinds of arteritis, the most common being the atherosclerotic, i.e. by deposition of fat inside the vessel with its clogging, but it true arteritis is thrombangeitis obliterans, the disease that I describe on this page;

- Have anyone of you had red sore throat? A severe red throat, for you couldn’t eat or drink any water? Has anyone sought an explanation for this state, how is it that you cannot even swallow? This swelling of the throat (pharynx) that anything cannot be swallowed is actually a bunch of leukocytes (white cells), other kinds of defense cells and all trash that collects in your throat is installed and a microbe has its way (streptococcus, staphylococcus and other kinds of beasts). The throat, the sentinels (tonsils) swell and the man cannot swallow and sometimes even breathe).

- You can ask again why I am talking about red throat and what links it to thrombangeitis. Just as in the throat, as the man cannot swallow well, and sometimes even breathe, the same thing happens in the arteries, they are swallow, thickening their walls and thus they no longer let blood pass through and the blood trapped inside makes clots;

- Returning to the disease we are talking about: thrombangeitis obliterans is a disease affecting young people, almost exclusively men. It is the medical finding that this disease not only attacks almost exclusively men, but especially the young ones, in their 40-45 years, sometimes very young, even of 30 years. The arteries are clogged, usually beyond the elbow and knees and eventually leave them with no legs or hands. The consequence is usually amputation.

- This disease is frightening and even so, it leaves you invalid and is not content with a hand or foot, it wants all. I myself have seen patients in Fundeni, who had both legs cut, a hand cut and the other hand remained in danger, because they made something with it that was the very source of their disease.

- The only data we have about this disease, as physicians, cardiovascular surgeon (called more frequently than other physicians to this disease and especially "stuck" to resolve such cases), are that it is a disease of the distal arteries to elbows and knees, which usually affects young men under 40 years and the sole finding regarding the habits is smoking; in non-smokers the disease is extremely rare, practically nonexistent.

- You can ask what disease is this, which is the cause and what can be done in order not to become invalid. As such the doctors have asked questions that had to do with patients with this disease and after researching and trying to understand, only found that in some smokers, almost exclusively male, arteries get inflamed (as in red throat) and get clogged by clots and thus the arteries no longer bring blood to the limbs (feet or hands), causes acute and/or chronic ischemia and thus gangrene occurs.

Doctors do not know what is from cigarettes (the smoke inhaled by the smoker) that causes the inflammation of the arteries. The example most often used in clinic for patients with this disease is that the allergy to detergent. To be clear, smokers’ arteritis, thrombangeitis obliterans is not an allergy, but acts as a strange reaction of the artery to something in cigarette smoke. We are all washing clothes with detergent, but some people are allergic to detergents and when they come into contact with clothes washed with detergent, they are allergic, get hives, eczema, even anaphylaxis (gag and it lowers their blood pressure). The hands of those people with allergies to detergents are sometimes "ugly", even painful, and itchy and the treatment is very complicated in some cases of allergy to detergent.
- If the causes (etiology) of arteritis is obscure (unclear) and the only clear finding is the link between the disease and smoking, there are still some good news on this disease.

- The role of doctor is just to emphasize the ray of light on the disease and the escape of mutilating amputations.

- Now the presentation will follow the solutions that can make the escape of amputation depending on how advanced is the disease when the patient reaches a doctor.

- The first and most important thing is finding the diagnosis. If you are male, under 40 years of age, smoker and you get a sore calf muscle when walking, or pain in the fingers or legs or hands, with their getting cold and their color changing, think no longer and go urgently to your family doctor (who knows what advice to give in this situation), to go directly to a cardiologist or a vascular or cardiovascular surgeon. In fact, the true specialist for the disease is the vascular surgeon, the only one who owns all means of struggle with the disease.

- Once the diagnosis is made, the specialist determines whether the case requires surgical treatment or does not and establish the appropriate treatment for each case.

Measures, in order of their importance, are:

• Smoking cessation: is over 50% of the treatment. Not giving up smoking compromises all available therapeutic means and ultimately leads to amputation.
• Medical treatment (conservative): anticoagulant, vasodilator, with prostaglandin (if available), antiaggregatory, anti-inflammatory and antibiotic, antialgic is established individualized for each case and is careful to choose the right medical regimen appropriate to the case and is made with the patient participation.
• Surgery: is applied to cases which have this indication. When it comes to gangrenes (necrosis) formed, the solution is amputation (ends of fingers, whole fingers, rays – the finger and thumb root represented by the metatarsus or metacarpian, front leg or hand, calf, forearm, thigh or arm. They may rarely “escape” only by removal of a nail or with one incision to evacuate the pus. Restorations of arterial flow (direct revascularization) are rarely possible due to the size of diseased arteries (small arteries) and multiple determinations. When they are possible, results are limited in time. Indirect revascularization through simpatectomy (lumbar or thoracic) is a surgical measure with limited effect in time (6 months).

I had no intention of writing a treatise on this disease. I will further expose my conclusions, quite hard on this disease and the reality as I see it.

1. Thrombangeitis obliterans is a disease of small arteries (distal of elbows and knees) affecting almost exclusively young men smoking. The mechanism by which this disease occurs, but apparently is due to a reaction of the body to "something" still unknown present in cigarette smoke;
2. Medical and surgical treatment has healing power lower than the harmful effect of continued smoking.
3. Smoking cessation is over 50% of the treatment and the key to healing.
4. Medical and surgical treatment is the interim solution in helping the patient until the effect of giving up smoking appears.
5. The patient heals himself in this disease by quitting smoking and the role of the doctor is to coordinate the patient in fighting this ruthless disease, by making a proper diagnosis, appropriate drug selection and performing surgery that essentially "gives time", respite, a second chance to show the beneficial effect of giving up smoking.
6. I do not claim that this page to replace a competent medical consultation, you will hear again at the cabinet many of those showed here and exactly what you need to be well; I hope that with this presentation I will help diagnose early and direct the first patients as early as possible to specialists for thrombangeitis obliterans (vascular or cardiovascular surgeon), the only specialist who possesses all the methods (medical and surgical) for fighting the disease.

---

Adauga:

| More...