A 24-year-old male smoker presents with claudication of both calves and a tender cord along the great saphenous vein that has migrated from its previous site three weeks ago. Angiography shows segmental occlusions of the tibial arteries with 'corkscrew' collateral vessels. Inflammatory markers are normal. What is the single most important intervention to prevent amputation?

• A Complete cessation of tobacco in all forms ✓
• B Lifelong aspirin plus cilostazol
• C Distal bypass grafting to the dorsalis pedis
• D Iliac angioplasty with stenting

Explanation

The young age, male sex, heavy smoking, migratory superficial thrombophlebitis, distal tibial occlusions and corkscrew collaterals are diagnostic of thromboangiitis obliterans (Buerger disease). Disease progression halts only with complete abstinence from all tobacco, including smokeless forms and nicotine replacement. Revascularisation options are limited because the disease affects distal vessels with no suitable target, so bypass and angioplasty fail unless smoking stops.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.