THROMBOANGIITIS OBLITERANS (Buerger Disease)

THROMBOANGIITIS OBLITERANS (Buerger Disease)

Buerger Disease

Buerger’s disease (also known as thromboangiitis obliterans) affects blood vessels in the body, most commonly in the arms and legs. Blood vessels swell, which can prevent blood flow, causing clots to form. This can lead to pain, tissue damage, and even gangrene (the death or decay of body tissues). Pathologic examination reveals arteritis in the affected vessels.

The cause is not known but it is rarely seen in nonsmokers. Arteries most commonly affected are the plantar and digital vessels of the foot and lower leg. In advanced stages, the fingers and hands may become involved. The incidence of Buerger disease has decreased dramatically.

Symptoms

The most common symptoms of Buerger’s disease are:

  • Fingers or toes that appear pale, red, or bluish
  • Cold hands or feet
  • Pain in the hands and feet that may feel like burning or tingling
  • Pain in the legs, ankles, or feet when walking—often located in the arch of the foot
  • Skin changes or small painful sores on the fingers or toes

Diagnosis

Buerger disease may be initially difficult to differentiate from routine peripheral vascular disease, but in most cases, the lesions are on the toes and the patient is younger than 40 years of age. The observation of super­ficial thrombophlebitis may aid the diagnosis. Because the distal vessels are usually affected, intermittent claudi­cation is not common with Buerger disease, but rest pain, particularly pain in the distal most extremity (ie, toes), is frequent. This pain often progresses to tissue loss and amputation, unless the patient stops smoking. The pro­gression of the disease seems to be intermittent with acute and dramatic episodes followed by some periods of remission.

MRA or invasive angiography can demonstrate the oblit­eration of the distal arterial tree typical of Buerger disease.

In atherosclerotic peripheral vascular disease, the onset of tissue ischemia tends to be less dramatic than in Buerger disease, and symptoms of proximal arterial involvement, such as claudication, predominate.

Symptoms of Raynaud disease may be difficult to differentiate from Buerger disease. Repetitive athero­emboli may also mimic Buerger disease and may be difficult to differentiate. It may be necessary to image the proximal arterial tree to rule out sources of arterial microemboli.

Treatment

Smoking cessation is the mainstay of therapy and will halt the disease in most cases. As the distal arterial tree is occluded, revascularization is not possible. Sympathec­tomy is rarely effective.

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