Thromboangiitis obliterans (Buerger disease) in a female mild smoker treated with spinal cord stimulation.

The authors report the case of a 42-year-old female mild smoker admitted to the Hospital of Ferrara for the onset of asymptomatic necrotic ulcerations localized to the second, third, and fourth toes of left foot. Physical examination showed asphygmia of inferior limb distal peripheral pulses, with localized extremity marbleized and cyanotic skin at the level of the left foot, where necrotic ulcers were present at the second, third, and fourth toes. Doppler ultrasonography and angiography revealed a severe obliterating arteriopathy of bilateral distal arterial circulation. Both blood chemistry panel (including autoimmune and hypercoagulable profile) and diagnostic examination findings were normal. Thus, the patient met several criteria to be diagnosed with Buerger disease. After an attempt at medical therapy with the intravenous administration of the prostaglandin-analogue iloprost, given the young age and the lack of viable distal target vessels for bypass grafting, a spinal cord stimulator was implanted. More than 2 years later, the patient has a normal life.