Diagnostic Test for Buerger’s Disease

Diagnoses.

Leslie (2004) said that no Formal set of diagnostic studies exist to determine if the patient has Buerger’s disease. It can be a diagnosis of exclusion after a complete history taking and physical examinations have been performed. The commonly followed diagnostic criteria are below although the criteria tend to differ slightly from author to author.

1.) Typically between 20-40 years old and male, although recently females have been diagnosed. 2.) Current (or recent) history of tobacco use. 3.) Presence of distal extremity ischemia In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischemia or ischemia (indicated by claudication, pain at rest, ischemic ulcers or gangrene) documented by noninvasive vascular testing such as ultrasound. 4.) Exclusion of other autoimmune diseases, hypercoagulable states, and diabetes mellitus by laboratory tests. 5.) Exclusion of a proximal source of emboli by echocardiography and arteriography. 6.) Consistent arteriographic findings in the clinically involved and noninvolved limbs.

Buerger’s disease can be mimicked by a wide variety of other diseases that cause diminished blood flow to the extremities. These other disorders must be ruled out with an aggressive evaluation, because their treatments differ substantially from that of Buerger’s Disease. For Buerger’s there is no treatment known to be effective.

Diseases with which Buerger’s Disease may be confused include atherosclerosis (build–up of cholesterol plaques in the arteries), endocarditis (an infection of the lining of the heart), other types of vasculitis, severe Raynaud’s phenomenon associated with connective tissue disorders (e.g., lupus or scleroderma), clotting disorders of the blood, and others (Domingo, 2007).

Angiograms of the upper and lower extremities can be helpful in making the diagnosis of Buerger’s disease. In the proper clinical setting, certain angiographic findings are diagnostic of Buerger’s. These findings include a corkscrew appearance of arteries that result from vascular damage, particularly the arteries in the region of the wrists and ankles. Angiograms may also show occlusions (blockages) or stenoses (narrowings) in multiple areas of both the arms and legs. The changes are particularly apparent in the blood vessels in the lower right hand portion of the picture (the ulnar artery distribution) (www.vascularweb.org).

In order to rule out other forms of vasculitis (by excluding involvement of vascular regions atypical for Buerger’s), it is sometimes necessary to perform angiograms of other body regions (e.g., a mesenteric angiogram).

Skin biopsies of affected extremities are rarely performed because of the frequent concern that a biopsy site near an area poorly perfused with blood will not heal well (www.vasculitisfoundation.org).

Doppler ultrasonography can detect the direction, velocity, and turbulence of blood flow. May show diminished circulation in the peripheral vessel (www.lifesteps.com).

Plethysmoghraphy is a test used to measure changes in blood flow or air volume in different parts of the body. It may be done to check for blood clots in the arms and legs, or to measure how much air you can hold in your lungs. It detects decreased circulation in the peripheral vessels (www.nlm.nih.gov).

Arteriography on the other hand is a common procedure done by injecting a dye by x-ray into the bloodstream. Then X-ray pictures are taken and studied to see if arteries are damaged. It locates lesions and rules out atherosclerosis (www.americanheart.org).

The Allen’s test the doctor may conduct a simple test called the Allen’s test to check blood flow through the arteries carrying blood to his/her hands. In the Allen’s test, onemake a tight fist, which forces the blood out of your hand. The doctor presses on the arteries at each side of his/her wrist to slow the flow of blood back into the hand, making his/her hand lose its normal color. Next, the client will open his hand and the doctor releases the pressure on one artery then the other. How quickly the color returns to the hand may give a general indication about the health of arteries. Slow blood flow into hand may indicate a problem, such as Buerger’s disease (www.mayoclinic.com).

Blood Test. A deficient in protein C or protein S, or even anti-thrombin III may also be associated with venous or arterial; occlusion and leads to rejection of the diagnosis (rheumatology.oxfordjournals.org). is also performed to identify other causes of narrowed or blocked arteries, such as inflammation of blood vessels due to autoimmune disorder. Such procedure include the erythrocyte sedimentary rate (ESR) and tests for C-reactive protein, which is produced only when inflammation is present (Beers, 2004).

Urinalysis creatinemia (The presence of excessive creatine in the blood) and studies of urinary sedimentary and proteinuria (albuminuria or urine albumin—is a condition in which urine contains an abnormal amount of protein) demonstrate the absence of renal damage suggestive of autoimmune diseases (www.rheumatology.org; www. medical-dictionary. The free dictionary.com ; kidney.niddk.nih.gov ).

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