achilles
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i would go for A-angiogram to determine the extent of the disease. angiograms are also diagnostic for thromboangitis obliterans and exclude other diseases that can mimic buerger's dz.
the only treatment that is effective for TO is smoking cessation. steroids and other anti-inflammatory agents or anticoagulants like aspirin are not effective. smoking cessation halts the progression of the disease ( i dont know if it reverses the disease and will make the patient completely normal one day, anyone can pls enlighten me on this ).
b,d and e are all surgical palliative measures and will be done in this patient only after an arteriogram and if the dz is disabling to the patients lifestyle or there is impending necrosis of the extremeties.
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| srf
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yes a is acorrect answer. if it is atherscerosis than aspirin & exercise works. not in tao.
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| aimhigh
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Hi, thanks for your replies. The correct answer is C (Srf, you were right!). Achilles, I also chose A and thought we needed angiogram since distal pulse absent...but it seems that angiogram is indicated for absent pulses for femoral or popliteal, not for distal aa.
Srf, could you please tell us more about why you chose C? Is that because this guy has Burger for less than 5 years? Is this the criterion for aspirin and conservative treatments. His hair loss and brittled nails won't change the treatment regimen, right?
Thanks!
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| srf
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this is why kaplan says do not chage your answer unless you have very strong reason to do so. when I first read q ,I was sure of answer c. But when I read explanation of archilles ,I thought he is right.
Any way I have faced this q somewhere. The explanation I remember is that which I have already given.if we can get result of tretment in more than 50% for more than 5 years, what more can we expect?
medical managemant if effective is always preferred over surgical options.we can always try other measure if medical management fails. this is all that I know.
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| achilles
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hi aimhigh, the explanation i gave is given in kaplan as well as CMDT...maybe i interpreted something wrong...pls help me with that.
but i think that if an angiography hasnt been done till now then we do need to do an angiography in this patient(for diagnostic purposes if not to determine the extent of disease) before we subject the patient to lifestyle changes which is the only effective treatment or not to miss giving him treatment for any other disease which can mimic TAO.
aspirin can be used to prevent the embolic complications of the disease(smoking is the only effective Rx-even a single fag will keep the disease active). but would we not want to go for an angiography before any treatment is started as the question also asks the next step ?
i might be missing something here in this question. pls help me with that.
atherosclerotic disease,emboli and autoimmune disease are in the differential diagnosis which can be excluded by angiography.
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" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
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| diyamirzah
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This patient has peripheral arterial disease.history of intermittent claudication.most common cause is atherosclerosis.Diagnosis is mainly clinical.edema weak or absent pulses.so in mild cases prevention of atherosclerosis is first step.if this fails or progressive symptoms& if the pulses are absent then ankle -brachial index is done or doppler to check pressure gradient, if they are positive surgery can be decided & now angiography is done to see the extent of disease before going for surgery.
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