A 28-year-old male heavy smoker presents with rest pain in both feet and two small digital ulcers on the right second toe. Examination shows absent dorsalis pedis and posterior tibial pulses bilaterally with normal femoral and popliteal pulses. He also has a tender cord along the left great saphenous vein that has migrated over the past month. Angiography shows abrupt segmental occlusions of calf vessels with corkscrew collaterals. Which single measure most alters the natural history of his disease?

• A Lifelong aspirin therapy
• B Complete abstinence from tobacco ✓
• C Proximal bypass grafting
• D Oral iloprost infusion

Explanation

This is thromboangiitis obliterans (Buerger disease), an inflammatory, highly cellular thrombotic occlusion of small and medium distal vessels seen almost exclusively in smokers. Disease activity ceases only with complete tobacco abstinence, including smokeless tobacco; continued smoking leads to gangrene and amputation. Proximal bypass fails because the target distal vessels are diseased, and iloprost only helps ulcer healing symptomatically. Aspirin does not alter progression. The migratory superficial thrombophlebitis and corkscrew collaterals are classic supportive findings.

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.