Patient Summary

Diagnosis

• Bilateral total vessel disease
• Stopped medicines & lost to follow-up
• Presenting complaint: C/o leg pain

Doppler Study Findings

Absent DP pulses bilaterally with preserved proximal flow suggests distal small vessel vasculitis — consistent with Buerger's disease (Thromboangiitis Obliterans) pattern in a young patient, or systemic small vessel vasculitis.

Prescribed Medications (Decoded)

First Visit Medications (1 month):

Management Principles for Bilateral Vasculitis (Lower Limb)

1. Lifestyle & Causative Factors

• Complete smoking cessation is the single most critical intervention (Bailey & Love, p. 1045)
• Avoid cold exposure, trauma to extremities
• Wound care for any ulcers

2. Pharmacological Management

• Aspirin 75 mg (antiplatelet) — as in Roverstat-A
• Cilostazol 50–100 mg BD — vasodilation + antiplatelet; improves walking distance and reduces claudication

• Isosorbide Mononitrate (Reno-MNP) — improves peripheral perfusion
• Nifedipine in Raynaud's component

• Rosuvastatin — anti-inflammatory + pleiotropic vascular benefit

• Calcium Dobesilate — reduces capillary permeability, anti-inflammatory at microvessel level

• Glucocorticoids + Rituximab — now standard initial therapy, particularly for ANCA-associated vasculitis (Harrison's, p. 12739)
• Cyclophosphamide + glucocorticoids — alternative
• Mepolizumab — for eosinophilic granulomatosis with polyangiitis

3. Investigations Recommended

• Duplex Doppler (done — bilateral)
• ANA, ANCA (p-ANCA/c-ANCA), anti-dsDNA
• ESR, CRP, CBC
• Ankle-Brachial Index (ABI)
• Angiography if surgical intervention considered

4. Surgical Options (if conservative fails)

• Sympathectomy (lumbar) — improves distal flow
• Revascularization — limited in distal disease
• Amputation — last resort if gangrene develops (Bailey & Love, p. 1045)

Key Points for This Case

1. Patient is 29F — young; Buerger's is more common in young male smokers, but vasculitis (autoimmune) should be strongly considered in a young woman
2. Absent DP bilaterally with preserved proximal flow = distal vessel involvement
3. Patient was lost to follow-up and stopped medications — medication adherence counseling is critical
4. 1-month follow-up prescribed — reassess symptoms, repeat Doppler if needed
5. Autoimmune workup (ANCA, ANA) should be done if not already completed given the demographic