Peripheral arterial disease treated with a multidisciplinary approach including sympathetic blockade, epidural blockade, and surgery

Abstract

Bürger disease is an inflammatory vascular disease clinically characterized by the development of thrombotic occlusions of the small- and medium-sized arteries of the distal extremities while sparing large arteries. We report here an unusual case of peripheral arterial disease, probably Bürger disease, complicated with severe abdominal aortic stenosis due to giant thrombus, which was successfully treated with a multidisciplinary approach including sympathetic blockade, epidural blockade, and surgery. A 40-year-old man presented with cyanosis, ulcer and gangrene in the toes, complicated with ischemic pain. His clinical symptoms and angiography results strongly suggested typical Bürger disease. Moreover, the angiography results also revealed severe stenosis in the abdominal aorta. His ischemic pain was ameliorated by medications, lumber sympathetic blockade and continuous epidural blockade. However, the ulcer and gangrene in the toes did not heal, although they stopped expanding. Thus, surgical treatment for the aortic stenosis was scheduled. Abdominal aortic replacement with a vascular prosthesis was successfully performed, resulting in a favorable outcome: he was able to avoid tissue loss and limb amputation. In this case, we suggest the possibility that peripheral arterial disease such as Bürger disease could involve the proximal arteries including giant arteries, and a multidisciplinary approach would be effective for the symptoms.