A 24-year-old man who smokes 20 cigarettes daily presents with severe claudication of both feet. Examination shows ischemic ulcers of the toes and a tender cord over the medial ankle. Angiography shows segmental occlusion of tibial and pedal arteries with normal proximal vessels. Biopsy of the involved artery shows an organizing thrombus infiltrated by acute inflammatory cells with microabscesses. What is the single most effective intervention?

• A Oral corticosteroids
• B Cilostazol plus antiplatelet therapy
• C Balloon angioplasty of tibial arteries
• D Complete cessation of tobacco use ✓

Explanation

This is Buerger disease (thromboangiitis obliterans), a segmental thrombosing inflammation of medium and small arteries of the extremities in young heavy smokers, often accompanied by superficial migratory thrombophlebitis (the tender cord). The disease is intimately linked to tobacco; continued smoking leads inexorably to gangrene and amputation, while complete abstinence halts progression. No drug or procedure matches smoking cessation in efficacy.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.