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Endarteritis or endarteritis obliterans, which is also known as spontaneous gangrene, Friedlander’s disease, or Buerger’s disease, is a disease of the peripheral blood vessels, which leads to its occlusion and violation of peripheral blood circulation to cause gangrene in the extremities, which kills the tissue and results in the darkening of the same.
Endarteritis obliterans has sometimes been incorrectly identified with obliterating atherosclerosis of the peripheral arteries. The distinction between these two diseases is of considerable practical importance.
The occlusive disease is characterized as a disease of young and middle age.
And the most significant changes occur in small blood vessels.
It often affects the arteries of the distal parts of the extremities, Frequently feet and legs.
On the other hand, atherosclerosis is a disease of the elderly, where the loss of vessels is more common, and the more profound changes occur in large blood vessels.
Etiology of endarteritis
The reasons that contribute to the development of endarteritis obliterans are diverse.
First, these factors that cause the long spastic condition of the peripheral vessels are associated with smoking (due to the vasoconstrictive action of nicotine).
Any chronic poisoning (for example, lead), cooling of the limbs or previous freezing, innervation disorders (chronic neuritis of the sciatic nerve, injuries of the extremities).
Some infections such as typhoid fever, syphilis, and, according to some authors, athletes’ feet also contribute to the development of the disease.
Something essential and unquestionable in the development of the disease is the chronic overload of the nervous system and, in the first place, its central departments, as well as the emotional factors that can cause prolonged vascular spasms.
Besides, the disease develops in the dysfunction of the autonomic nervous system and consequently the interruption of the endocrine activity; in particular, the violation of the hormonal function of the sexual glands and adrenal glands.
Origin and history of this affection
The frequency of diseases such as endarteritis increased during the first and second world wars and the first postwar years.
The curious thing about this historical fact is that beyond merely anecdotal, this could give more evidence in favor of the neuro-psychological factor that would come into play in developing the disease.
In other words, the origin of the disease is a congenital lability vessel with a predominance of spastic reactions. The pathogenesis of endarteritis obliterans is not so easy to determine. Well, schematically, it can be represented in the following way:
The spasm of the vessels prevails. First is the functional disorder that causes prolonged exposure to organic changes of the vascular wall, thickening the ship’s inner lining and forming a barrier of blood clots.
In the same way, endothelial destruction can be found in the development of the disease, depriving the endothelial parts of the vessel that produce the blood clots. Also, the intense pain stimulation causes humoral changes that promote blood clots – increased blood clotting and hyperadrenalism.
The organic changes of a vascular wall lead to a decrease in light and create the possibility of its complete obliteration. The pathological process is not limited to the great vessels since similar changes would occur in the collateral network; in some cases, their loss is even, but it could be later in others.
The first phase of collateral circulation is insufficient, but only in the lower part of the functional legs while walking (relative failure).
Then the absolute absence of collateral circulation develops, as evidenced by intense pain during walking (intermittent claudication) and the rest, especially in a horizontal position.
Other descriptions of endarteritis
In the case of endarteritis, it should be noted that until the sun today, it can be said that there are few options and alterative classification of endarteritis obliterans.
However, it should be kept in mind that there are often two forms of this disease: Arterial and arteriovenous.
In the latter case, it would be described by Dr. Burger (L. Buerger) as “migratory thrombophlebitis.”
However, it later turned out that this disease, much to the surprise of the scientific community, was only a variation of endarteritis obliterans.
The fact is that the medical community of that time realized that this was not just a phase of the process that began affecting the small peripheral veins of the extremities or peripheral arteries.
Other causes of endarteritis
In the case of endarteritis obliterans, considered a polyetiological disease, the underlying reasons for its appearance are very diverse; hence its adjective, polietiológica.
The reasons underlying its appearance include:
1) Some factors of infection, namely fever, but also syphilis, and even dermatophytosis
2) Factors that cause the long spastic condition of the peripheral vessels are chronic intoxication (lead, nicotine), prolonged cooling, especially causing freezing, and Innervation disorders (chronic neuritis of the sciatic nerve).
3) emotional factors that serve the cause of vascular spasm, congenital or acquired lability with a predominance of vasoconstrictor reactions;
- The chronic overload of the nervous system, as well as its central departments, which the most outstanding is the deterioration of the autonomic nervous system and consequently the disruption of the endocrine action, in particular, the transgression of the hormonal function of the sexual glands and the adrenal gland.
