Buerger's disease is an inflammatory, nonatheromatous occlusive condition that causes segmental lesions and subsequent thrombus formation in the small and medium-sized arteries (and sometimes the veins), resulting in decreased blood flow to the legs and feet. It's also called thromboangiitis obliterans.

This disease affects the legs more commonly than the arms. Cerebral, visceral, and coronary vessels may also be affected. Incidence is highest among men of Asian and Jewish ancestry, ages 20 to 40, who smoke heavily.

Causes of Buerger's Disease

Although the cause of Buerger's disease is unknown, a definite link exists to smoking and an increased incidence of human leukocyte antigen (HLA)-B5 and HLAA9, suggesting a hypersensitivity reaction to nicotine.

In the initial stages of the disease, polymorphonuclear leukocytes infiltrate the walls of the small and medium-sized arteries and veins. The internal elastic lamina is preserved, and a thrombus may develop in the vascular lumen. As the disease progresses, mononuclear cells, fibroblasts, and giant cells replace the neutrophils. In later stages, perivascular fibrosis and recanalization occur.

Signs & Symptoms of Buerger's Disease

Symptoms of Buerger's disease appear in the hands and feet and may include:

Enlarged, red, tender cord-like veins
Pain or tenderness
Pain may increase with activity such as walking and decrease with rest
Pulse may be decreased or absent in the affected extremity
Numbness and tingling in the limbs
Symptoms may worsen with exposure to cold or with emotional stress
The hand or foot feels cold, sweats a lot and turns bluish, probably because the nerves are reacting to severe, persistent pain.

Diagnostic Tests

Diagnosis is usually made from the clinical symptoms. Patients frequently complain of numbness, tingling, or burning sensations in the affected area before evidence of vascular inflammation becomes apparent.

Treatment

Abstention from smoking tobacco is essential. An exercise program that uses gravity to fill and drain the blood vessels may also help in mild to moderate disease. Severe disease may require a lumbar sympathectomy or arterial bypass to increase blood supply to the skin. Parenteral or oral antibiotics may be used to treat secondary infections. Amputation may be necessary for nonhealing ulcers, intractable pain, or gangrene.

Prevention Tips

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