CURRENT SCENARIOS IN MANAGEMENT OF BUERGER'S DISEASE AT TERTIARY HOSPITAL UTTARAKHAND

Abstract

Introduction / Background: Buerger's disease is a systemic vasculitis of unknown etiology, strongly associated with tobacco abuse worldwide. Buerger described Thromboangiitis obliterans (TAO) in 1908. High prevalence is found in Asian / Middle East countries. The survival rate of TAO is almost 90%. Presently, total abstinence from tobacco is the mainstay of treatment. Aim: To determine the incidence, progression, etiology, impact of seasonal variations on admission, as well as, presentations, and treatment outcomes at our tertiary health care hospital in Uttarakhand region. Materials: Patients of Buerger's disease admitted to our Institute during January 2015 to December 2019, were included in this study. Methods: Retrospective analysis and study of 142 patients of Buerger's disease admitted at our institute. Results: Most patients were males (97%), with mean age 38.6 years. The incidence & total TAO admission were overall decreasing during these years. Trends showed that eighty two (58%) patients were admitted between months of November to February (cold weather), while least in summers (15%). More than 50% were severe smokers (>30 bidi / cigarette per day). Pain in limbs was present in 77.4% cases. Major amputations were done in (12) 8% cases, while digital / finger / forefoot amputations in 31.69% / 3.52% / 10.58.% cases respectively. Lumbar sympathectomy was done in twelve cases. The median requirement of analgesic (opioids) by intravenous & oral route was 10 & 12 doses initially, & mean VAS score on day-1, 5 & 10 was 6.4, 4.1 & 2.9 respectively. Conclusion: We conclude that incidence of TAO overall shows a decreasing trend, with better health practices. Admissions peak in the cold season, along with complaints related to painful / ulcerated limbs, with a strong association with tobacco abuse. Complete stopping of tobacco can halt further progression of TAO.