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PVD > Buerger's Disease

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.

Symptoms

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.

Diagnosis

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 others.

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

Treatment is focused on removing all factors that may reduce blood supply:

Abstain from tobacco use in all forms
Avoid drugs which constrict the blood vessels
Avoid injury from heat or cold
Avoid tight or restrictive clothing
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 infections immediately
Report all injuries to your family care physician for appropriate treatment

Dr. Pankaj Patel a vascular surgeon has expertise in peripheral vascular diseases, varicose veins and deep vein thrombosis