A 24-year-old male heavy smoker presents with rest pain in both feet. Examination shows absent dorsalis pedis and posterior tibial pulses with normal femoral and popliteal pulses. He had an episode of migratory superficial thrombophlebitis last year. Angiography shows segmental occlusions of distal tibial arteries with 'corkscrew' collaterals. Which is the single most important intervention to prevent amputation?

• A Iliac artery angioplasty and stenting
• B Lifelong complete cessation of tobacco use ✓
• C Lifelong warfarin anticoagulation
• D Lumbar sympathectomy

Explanation

This is thromboangiitis obliterans (Buerger disease), an inflammatory occlusive condition of small and medium vessels of young male smokers. Disease progression and amputation risk track directly with continued tobacco exposure in any form, including chewing tobacco; complete abstinence is the only measure proven to alter the course. Revascularisation is usually impossible because the disease is distal and diffuse, sympathectomy only helps rest pain temporarily, and anticoagulation has no role.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.