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1/14. Vascular reconstruction in Buerger's disease.

    In 23 of 148 patients with Buerger's disease, it was possible to undertake 27 arterial reconstructive procedures: bypass in 22 and thrombo-endarterectomy in 5. In a follow-up of 10 months to 8 years, the overall patency rate was 26 per cent. The long term patency rate of bypass grafting was good in obstruction of main vessels, but unsatisfactory with multiple occlusions. Bypass grafting was preferred to thromboendarterectomy. To obtain long term patency of revascularaized segments, complete abstinence from tobacco is absolutely essential. The preparatory manoeuvres for antogenous venous graft should be as atraumatic as possible. A functional diagnosis is indispensable when considering operative indications and for follow-up study of patients with peripheral arterial occlusive disease.
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keywords = tobacco
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2/14. Implantable spinal cord stimulator to treat the ischemic manifestations of thromboangiitis obliterans (Buerger's disease).

    thromboangiitis obliterans (Buerger's disease) is a segmental inflammatory vasculitis that involves the small-sized and medium-sized arteries, veins, and nerves. It is causally related to tobacco use. The diagnosis is usually made on the basis of the presence of distal arterial disease in individuals who smoke and in whom other disease entities have been excluded. The most effective treatment for Buerger's disease is smoking cessation. Without strict adherence to tobacco avoidance, disease progression is likely. methods to control ischemic pain include medications, sympathectomy, or surgical revascularization. The effect of sympathectomy is unpredictable, and the chances of a successful revascularization procedure are rare because distal target vessels often are extensively diseased. Herein, we describe a patient whose condition did not respond to the usual conservative therapy but did respond dramatically to the implantation of a permanent spinal cord stimulator. Although these devices have been used for more than 20 years in various other peripheral arterial diseases, their use in Buerger's disease has been limited.
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keywords = tobacco
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3/14. Cerebral vein thrombosis in a case with thromboangiitis obliterans.

    thromboangiitis obliterans is a chronic inflammatory vessel disease that involves predominantly the small and medium-sized arteries and veins of the distal extremities. Appearance and cessation of symptoms are closely related to patterns of tobacco consumption. That cerebral arteries can also be involved is shown by reports of rare cases in which cerebral artery occlusion led to infarction. We report on a 28-year-old man with thromboangiitis obliterans who developed extensive cerebral vein thrombosis after a single episode of cigarette smoking following several years of nonsmoking. Despite extensive evaluation, no other known cause or predisposition of cerebral vein thrombosis could be found. This case suggests that cerebral veins can be involved in thromboangiitis obliterans and patients with thromboangiitis obliterans might be at risk for cerebral vein thrombosis.
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keywords = tobacco
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4/14. Treatment of Buerger's disease with electrical spinal cord stimulation--review of three cases.

    Buerger's disease or obliterating thromboangiitis is an inflammatory pathologic condition affecting the distal vascular segments; it strikes young adults, especially males and heavy smokers. Medical and surgical treatment often fail to heal these patients, especially considering the frequent relapse of this disease linked with tobacco abuse--definitive healing often involves limb amputation. Electrical spinal cord stimulation is evaluated in this study with an analgesic aim and for improvement in skin microcirculation, with the goal of long-term healing of diseased limbs.
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keywords = tobacco
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5/14. cannabis arteritis.

    The main causes of arteriopathy in young patients include drugs, metabolic diseases, pseudoxanthoma elasticum and Buerger's disease. arteritis due to cannabis indica was first reported in 1960, and the role of this drug as a risk factor for arteritis was confirmed in several subsequent publications. A 38-year-old smoker with no previous contributory medical history except for long-standing cannabis abuse developed a dry necrotic lesion of the left big toe. Imaging examinations revealed proximal arteriopathy of the lower limbs that predominated on the left side. He had no atherogenic or thrombogenic risk factors, and no signs of pseudoxanthoma elasticum were found. Remarkably, the development of arteritis paralleled cannabis abuse. The course was slowly favourable after weaning from the drug, vasodilator treatment and hyperbaric oxygen therapy. Despite some subtle clinical differences (more proximal than distal involvement), cannabis arteritis may be considered as a particular form of Buerger's disease, where cannabis, along with tobacco, seems to cause arterial lesions. Along with the noxious effects of cannabis on vessels, a role for contaminating arsenic is also possible. cannabis arteritis is not widely known, but may prove not to be so rare if one considers consumption of cannabis besides that of tobacco.
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6/14. Buerger's disease and pulmonary hypertension: a rare association?

    thromboangiitis obliterans (TAO), Buerger's disease, is an inflammatory thrombotic occlusive vascular disorder that typically involves small and medium-sized arteries of both the upper and lower extremities. This disease usually affects young adult males between the ages of 40 and 45 years old who smoke tobacco products. Clinically significant extrapulmonary involvement is exceptional. We describe a patient with elevated pulmonary arterial pressures associated with TAO who had no other discernible causes of secondary pulmonary hypertension.
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7/14. thromboangiitis obliterans (Buerger's disease) in a saphenous vein arterial graft.

    thromboangiitis obliterans (Buerger's disease) is an uncommon variety of occlusive peripheral vascular disease, occurring predominantly in young male tobacco smokers. The vascular lesion in the acute stage of thromboangiitis obliterans is distinctive and affects both the arteries and veins. Described here is an unusual case of thromboangiitis obliterans occurring in a saphenous vein used for coronary artery bypass graft in a middle-aged man who, against advice, had continued to smoke after the myocardial revascularization surgery. To the author's knowledge, thromboangiitis obliterans in arterial vein graft has not been reported previously.
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8/14. thromboangiitis obliterans (Buerger's disease) and smokeless tobacco.

    thromboangiitis obliterans, a distinct clinical and pathologic entity characterized by segmental inflammatory and proliferative lesions of the tunica media of small arteries and veins, has been reported frequently in men who have a history of heavy cigarette smoking. We report a case of thromboangiitis obliterans in a 38-year-old man that was clearly associated with the use of smokeless (chewing) tobacco. In addition to a physical history and examination and laboratory evaluation, a biopsy of the skin and deep subcutaneous tissue of the patient's left thigh was performed, and this revealed occlusion of 2 large dermal blood vessels by a highly organized thrombus. A regimen of nifedipine and antiplatelet therapy, plus complete abstinence from tobacco, resulted in resolution of the patient's symptoms and pain. Our findings may be of particular importance in view of the increasing popularity of smokeless tobacco and the complications which may result from its use.
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keywords = tobacco
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9/14. thromboangiitis obliterans (Buerger's disease) in an elderly man after cessation of cigarette smoking--a case report.

    thromboangiitis obliterans (Buerger's disease) is an occlusive vascular disease that occurs almost exclusively in young male tobacco users. A unique case is documented here in which Buerger's disease affecting the upper limbs was diagnosed in a sixty-two-year-old man who was a cigarette smoker but had stopped smoking fifteen years earlier.
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10/14. Mesenteric involvement of thromboangiitis obliterans (Buerger's disease) in a woman.

    Although patients with peripheral arterial occlusive disease due to thromboangiitis obliterans (TAO) have been well characterized and the relationship of this disease to tobacco is stressed, little attention has been focused on its ability to involve the mesenteric vasculature and its ability to affect women. We report a rare case of a known TAO female patient who presented with abdominal pain due to inflammatory changes of the mesenteric vessels. The resulting small bowel ischemic changes and formation of intramural gas were demonstrated on a small bowel follow-through and a plain abdominal film. An angiography finally showed a superior mesenteric artery occlusion.
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