Hello and welcome to the Zero to Finals podcast.

My name is Tom and in this episode I'm going to be talking to you about Burger Disease.

And you can find written notes on this topic at zero to finals.com slash burger disease

or in the vascular surgery section of the Zero to Fininals surgery book. So let's get straight into it.

Berger disease is also known as thromboangitis obliterans. It's an inflammatory condition that causes

thrombus formation or blood clots in the small and medium-sized blood vessels

in the distal arterial system which affects the hands and the feet

Berger disease typically affects men aged 25 to 35 and it has a very strong association with smoking. Notable features which also form part of

the diagnostic criteria for making a diagnosis are that patients are younger than 50 years of age

and do not have risk factors for atherosclerosis other than smoking.

Let's talk about the presentation.

The typical presenting feature is painful, blue discoloration of the fingertips or the tips of the toes.

The pain is often worse at nighttime.

And this discoloration may progress to ulcers, gangrene and amputation of the digits. A typical finding on angiograms is corkscrew collaterals, where new collateral vessels form to

bypass the affected arteries. Finally, let's talk about management.

Completely stopping smoking is the main component of treatment.

This usually results in a significant improvement in symptoms.

Cutting down on smoking or using nicotine replacement products

does not seem to be adequate to improve the condition.

So they need to stop nicotine and smoking completely.

Other specialist treatments may be considered including something called intravenous isloprost.

Iloprost is a prostociclin analogue that dilates blood vessels, so improves the blood flow.

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