TAO is a chronic occlusive disease characterized by segmental, nonsuppurative inflammation and intra-arterial thrombosis of the small and medium-sized arteries, mainly involving the small and medium-sized arteries in the distal extremities. The disease occurs in young and middle-aged men with a history of smoking and is often associated with wandering superficial phlebitis of the affected limbs and Raynaud’s syndrome. The disease is also known as Buerger’s disease.
Etiology.
The exact etiology is still unknown. It is associated with smoking, cold and infection, sex hormones, vascular neuromodulation disorders, trauma, and immune factors.
Pathological features.
1, mainly invades the blood vessels of the lower extremities.
2, mainly involving medium and small arteries.
3, the whole layer of the vascular wall of the lesion shows non-suppurative vasculitis lesions.
4, the lesions are segmental.
5, a few patients in the late stage of the lesion, the vessel wall and perivascular tissue is extensively fibrotic, arteries, veins and nerves can be surrounded by fibrous tissue, forming a stiff cord, and the formation of collateral circulation can be seen around.
Clinical manifestations: pain, chills and sensory abnormalities, skin color changes, wandering superficial thrombophlebitis, dystrophic lesions, diminished or absent arterial pulsations, gangrene or ulcers.
Ancillary tests: ultrasound, CTA, MRA, arteriography.
Treatment.
The principle is mainly to prevent the progress of lesions, improve and increase the blood circulation of the affected limbs, relieve symptoms and improve the quality of life of patients.
1.General measures: smoking cessation, exercise therapy.
2.Medication: vasodilators, antiplatelet agents, anticoagulants, improve circulation, avoid thrombosis, hormones, antibiotics to control the inflammatory flare-ups that occur in the blood vessels and slow down the progress.
3.Hyperbaric oxygen therapy
4.Surgical treatment
(1) Traditional surgical treatment: lumbar sympathectomy, endovascular stripping, bypass diversion, large omental transplantation, staged arteriovenous diversion.
(2) Minimally invasive surgery: percutaneous transluminal angioplasty (PTA), drug box implantation.
5.Chinese herbal medicine treatment