A 24-year-old male smoker has painful ulcers on his right great toe and fingers of both hands. Angiography shows segmental narrowing and occlusion of the digital, palmar, and tibial arteries with corkscrew collaterals. Biopsy of an involved artery shows an organizing thrombus containing microabscesses within a neutrophilic infiltrate. Which intervention offers the best chance of preventing amputation?

• A Intravenous prostacyclin infusion
• B Complete cessation of tobacco use ✓
• C High-dose corticosteroids
• D Lumbar sympathectomy

Explanation

This is thromboangiitis obliterans (Buerger disease), an inflammatory, highly cellular thrombosing vasculitis of small and medium arteries and veins in the distal extremities of heavy smokers. The thrombus with neutrophils and microabscesses is characteristic. Tobacco abstinence is the only measure proven to halt progression; continued smoking leads inexorably to gangrene and amputation regardless of other therapy.

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.