A 26-year-old male smoker presents with rest pain and digital gangrene of the right foot. He has had recurrent episodes of tender nodules along the superficial leg veins that migrated over weeks. Angiography shows occlusion of infrapopliteal arteries with corkscrew-shaped collaterals; the proximal arteries are normal. Which single measure most influences limb salvage?

• A Complete and permanent abstinence from tobacco in any form ✓
• B Long-term oral anticoagulation with warfarin
• C Distal bypass grafting with autogenous vein
• D Lifelong prostacyclin infusion therapy

Explanation

This is thromboangiitis obliterans (Buerger disease): a young male smoker with distal arterial occlusion, corkscrew collaterals and migratory superficial thrombophlebitis. Disease activity is driven entirely by tobacco exposure, including smokeless tobacco, so absolute cessation is the only measure that halts progression; patients who continue smoking face a high amputation rate regardless of other therapy. Proximal vessels are healthy and the distal target vessels are diseased, which makes bypass technically poor, killing option C.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.