Current Concepts in the Management of Thromboangiitis Obliterans (TAO) Using Distraction Osteogenesis
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REVIEW ARTICLE
Current Concepts in the Management of Thromboangiitis Obliterans (TAO) Using Distraction Osteogenesis Arnab Sain 1
&
Hemant Bansal 1
&
Sitender Garg 1
Received: 4 July 2020 / Accepted: 22 October 2020 # Association of Surgeons of India 2020
Abstract Buerger’s disease or thromboangiitis obliterans (TAO) is a disease of unknown aetiology. It involves progressive segmental inflammation of small- and medium-sized blood vessels of the limbs which leads to the manifestations of chronic vascular ischemia of peripheral vessels. It is a limb-threatening condition and has a strong association with chronic smoking. The management of TAO has always remained controversial with the number of medical and surgical treatments available. However, so far, none of them has proved to be consistent and promising with the outcomes. The main principle of the management of TAO is to restore the vascular supply of the affected limb to elude pernicious complications like amputation. Since 1989, Ilizarov’s method of bone transport has been widely used with satisfactory outcomes to treat bone defects and for limb reconstruction. This principle of distraction osteogenesis not only promotes bone formation but also the adjoining soft-tissue growth. This advantage has been popularized over decades for its significant implication in the neovascularization of ischemic limb in the management of TAO. Keywords Buerger’s disease . Thromboangiitis obliterans . TAO . Distraction osteogenesis . Current concepts
Introduction Thromboangiitis obliterans (TAO), also known by the name of Buerger’s disease, is a rare vascular disease characterized by thrombosis in medium-sized blood vessels in arms and legs along with a marked inflammatory response. In the lower limb, it mainly affects the arteries distal to the knee characterized by absent popliteal, posterior tibial, and dorsalis pedis pulses with a palpable femoral pulse [1]. TAO was first introduced by Felix Von Winiwarter, who named it an Endarteritis [2]. In 1908, Leo Buerger gave its detailed description and called it thromboangiitis obliterans [3], which was also popularized by his last
* Hemant Bansal [email protected] Arnab Sain [email protected] Sitender Garg [email protected] 1
Department of Orthopedics, JPN Apex Trauma Centre, AIIMS, New Delhi, India
name. TAO is the most common in the age group of 20–40 years and encountered more commonly in men and in chronic smokers; however, cases have also been reported in women and non-smokers [1, 3–5]. The clinical features of TAO are that of distal vascular insufficiency, with patients having manifestations of rest pain, claudication, and toe ulcers [6]. As smoking is a constant associated risk factor in the pathogenesis of TAO, its discontinuation has been proved to be an effective treatment [7–9]. Besides, some medications have also been found to be beneficial such as cyclophosphamide [10], clofibrate [11], iloprost [12], and calcium channel blockers [13]. Various surgical modalities have been postulated in the
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