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

AbstractBurger 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 Burger 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 Burger 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 trea...