Buerger's Disease, also known
as Thromboangitis Obliterans, involves the small and medium-sized
arteries. Frequently, it involves superficial veins of the extremities.
Rarely, and in well advanced disease, it may involve vessels in
other parts of the body.
This disease was first reported by
Buerger in 1908, who described a disease in which the characteristic
pathologic findings - acute inflammation and thrombosis (clotting)
of arteries and veins - affected the hands and feet. Another name
for Buerger's Disease is thromboangiitis obliterans.
Buerger's Disease occurs most
commonly in men aged 20 to 40 who smoke cigarettes. The cause is
unknown, but the relationship of smoking to the occurrence and progression
of the disease is apparent. Cigarette smoking has been implicated
as a primary etiologic factor.
Who gets Buerger's Disease
(the "typical" patient)?
The classic Buerger's Disease patient is a young
male (e.g., 20-40 years old) who is a heavy cigarette smoker. More
recently, however, a higher percentage of women and people over
the age of 50 have been recognized to have this disease. Buerger's
disease is most common in the Orient, Southeast Asia, India and
the Middle East, but appears to be rare among African-Americans
Onset is gradual and begins
in the small vessels (affecting toes first). Sensation of coldness,
numbness, prickling, tingling and/or heightened sensitivity of the
foot or pain confined to one toe. Raynauds's phenomenon is common.
Pain while walking but that is relieved by resting may occur (usually
in the arch of the foot or the leg, but rarely the hand, arm, or
thigh. Persistent pain will be present as the disease progresses
to more severe arterial blockage causing ulcerations and pregangreneous
or gangrenous changes. Progression to the acute stage usually occurs
in patients who continue to smoke and may produce so much damage
that amputation is necessary.
Non-Invasive vascular studies
can detect a decrease in blood flow and pressure in the toes, foot,
and/or fingers. Physical examination will reveal diminished or absent
pulses in one or more of the pulses in the foot. Color changes can
also be detected during certain physical maneuvers.
Buerger's disease can be mimicked by a wide variety of other diseases
that cause diminished blood flow to the extremities. These other
disorders must be ruled out with an aggressive evaluation, because
their treatments differ substantially from that of Buerger's Disease
(for Buerger's, there is only one treatment known to be effective:
complete smoking cessation - see below).
Diseases with which Buerger's Disease may be confused include atherosclerosis
(build-up of cholesterol plaques in the arteries), endocarditis
(an infection of the lining of the heart), other types of vasculitis,
severe Raynaud's phenomenon associated with connective tissue disorders
(e.g., lupus or scleroderma), clotting disorders of the blood, and
Angiograms of the upper and lower extremities can be helpful in
making the diagnosis of Buerger's disease. In the proper clinical
setting, certain angiographic findings are diagnostic of Buerger's.
These findings include a "corkscrew" appearance of arteries
that result from vascular damage, particularly the arteries in the
region of the wrists and ankles. Angiograms may also show occlusions
(blockages) or stenoses (narrowings) in multiple areas of both the
arms and legs.
Treatment is focused on removing all factors that may reduce blood
||Abstain from tobacco
use in all forms
||Avoid drugs which constrict
the blood vessels
||Avoid injury from heat
||Avoid tight or restrictive
|| Avoid sitting or standing
in one position for long periods
||Do not walk barefoot
in order to avoid injury
||Shoes and stockings
should fit properly
||Avoid minor surgery
of the toes
||Seek treatment for fungal
||Report all injuries
to your family care physician for appropriate treatment