[MO-63] Presentation Awards
A case of struggling with diagnosis of Buerger disease
We described a 49-year-old woman with intermittent claudication and rest pain to cyanosis of left leg. Past medical history is mammary gland fibroadenoma. She had no hypertension, diabetes mellitus, dyslipidemia and Smoking. However, passive smoking was revealed from 18 years old to current. 1 year before, she complained left intermittent claudication. And endovascular treatment (EVT) to chronic total occlusion of left iliac artery was performed at other hospital. Her symptom was improved after EVT. However, intermittent claudication was recurrence after 6 months and furthermore rest pain to cyanosis of left leg was appeared 3 months ago.Then she visited our hospital. Angiography indicated re-stenosis of iliac stent site, but proximal lesion alone could not cause critical limb ischemia. And we perfomed more detailed angiography of distal lesion, Further angiography showed patency of femoropopliteal artery, interruption of distal artery, occlusion of digital artery and corkscrew collaterals around occulusive area. Although the patient was female and had no smoking habit, patient had passive smoking, onset in less than 50years old, no evidence of atherosclerosis, no appearance source of emboli and no systemic inflammatory disease for example lupus erythematosus, vasculitis and so on. The patient was diagnosed as Buerger disease. In this case, for claudication EVT to restenosis of iliac lesion was performed and for rest pain to cyanosis medical therapy was started. And claudication was improved immediately after EVT, rest pain to cyanosis was gradually getting better by medical treatment. In this case, involvement of the proximal iliac lesion and female without smoking habits had made diagnosis of Burger disease difficult. Also, in Burger disease, involvement of proximal iliac lesion was reported about 7%. Furthermore, female patients are reported about 5% to 20% in Burger disease and this patient was exposed to passive heavy smoking. A valuable case is reported here.