A 24-year old man seeks medical attention for complaints of claudication in the arch of the foot. A nurse also notes superficial thrombophlebitis of the lower leg. The nurse would next assess the client for:
A. Familial tendency toward peripheral vascular disease.
B. Smoking history.
C. Recent exposures to allergens.
D. History of insect bites.
Correct Answer: B. Smoking history
The mixture of arterial and venous manifestations (claudication and phlebitis, respectively) in the young male client suggests Buerger’s disease. This is an uncommon disorder characterized by inflammation and thrombosis of smaller arteries and veins. This disorder typically is found in young adult males who smoke. The cause is not known precisely but is suspected to have an autoimmune component.
Option A: A genetic link may exist as affected subjects have an increased prevalence of human leukocyte antigen (HLA)-A9, HLA-B5, and HLA-54. Although the disease is common in Asia, North American males do not appear to have any particular predisposition, as the diagnosis is made in less than 1% of patients with severe limb ischemia.
Option C: There is no definitive etiology of TAO, yet tobacco exposure is required for both disease initiation and progression. The mechanism of the disease remains a mystery, but it may involve immunologic dysfunction and tobacco hypersensitivity that is associated with enhanced cellular sensitivity to type-I and type-III collagen, impaired endothelium-dependent vasorelaxation, and increased anti-endothelial cell antibody titers.
Option D: Patients with Buerger disease may have specific cellular immunity against arterial antigens, specific humoral anti-arterial antibodies, and elevated circulatory, immune complexes, but a precise diagnosis can be made only by tissue histology.
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