A 24-year-old male smoker has ischaemic ulceration of two toes with normal femoral and popliteal pulses. Angiography shows segmental occlusions of tibial vessels with corkscrew collaterals. He had an episode of migratory superficial thrombophlebitis last year. Which intervention offers the greatest chance of healing and limb salvage?

• A Femoropopliteal bypass grafting
• B Complete abstinence from tobacco in all forms ✓
• C Lifelong oral anticoagulation with warfarin
• D Balloon angioplasty of the tibial vessels

Explanation

This is thromboangiitis obliterans (Buerger disease), an inflammatory, non-atherosclerotic, segmental occlusion of small and medium vessels of young heavy smokers. Disease activity and progression are directly linked to tobacco exposure, including smokeless forms, and complete cessation halts progression and preserves limbs; continued smoking leads to major amputation. Distal tibial disease makes bypass or angioplasty technically poor options, and no drug therapy alters the course.

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.