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Buerger's disease

Buerger's disease (also known as thromboangiitis obliterans) is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. It is strongly associated with use of tobacco products, primarily from smoking, but also from smokeless tobacco. more...

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Features

There is an acute inflammation and thrombosis of arteries and veins of the hands and feet. The main symptom is pain in the affected areas. Ulcerations and gangrene in the extremities are common complications, often resulting in the need for amputation of the involved extremity.

Diagnosis

A concrete diagnosis of thromboangiitis obliterans is often difficult as it relies heavily on exclusion of the conditions. The commonly followed diagnostic criteria are below although the criteria tend to differ slightly from author to author. Olin (2000) proposes the following criteria:

  1. Age younger than 45 years
  2. Current (Or recent) history of tobacco use
  3. Presence of distal extremity ischemia (indicated by claudication, pain at rest, ischemic ulcers or gangrene) documented by noninvasive vascular testing such as etc
  4. Exclusion of autoimmune diseases, hypercoagulable states and diabetes mellitus by laboratory tests.
  5. Exclusion of a proximal source of emboli by echocardiography and arteriography
  6. Consistent arteriographic findings in the clinically involved and noninvolved limbs.

Pathophysiology

There are characteristic pathologic findings of acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet (the lower limbs being more common). The mechanisms underlying Buerger's disease are still largely unknown. It is suspected that immunological reactions play a role.

Treatment

Immediate and absolute cessation of tobacco use is necessary to prevent any further progression of the disease. Even a few cigarettes a day or nicotine replacements can keep the disease active. Vascular surgery can sometimes be helpful in treating limbs with poor perfusion secondary to this disease.

Prognosis

Buerger's disease is rarely fatal, but amputation is common in patients who continue to use tobacco. It often leads to vascular insufficiency.

Prevention

The disease occurs exclusively in tobacco users, so not using tobacco prevents you from getting the disease. Diet has no influence.

Epidemiology

Prevalence of the disease has decreases with the decreased prevalence of smoking. It is more common among men. It is more common in Israel, Japan and India than in the United States and Europe. The disease is most common among natives of Bangladesh, who smoke special cigarettes made of raw tobacco (bidi).

History

Buerger's disease was first reported by physician Leo Buerger in 1908.

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Buerger's disease
From Gale Encyclopedia of Medicine, 4/6/01 by John T. Lohr

Definition

Buerger's disease is an inflammation of the arteries, veins, and nerves in the legs, principally, leading to restricted blood flow. Left untreated, Buerger's disease can lead to gangrene of the affected areas. Buerger's disease is also known as thromboangitis obliterans.

Causes & symptoms

The exact cause of Buerger's disease is not known. It is seen most often in young to middle-aged men (ages 20-40) who are heavy smokers of cigarettes. Cases of this disease in non-smokers are very rare, hence, cigarette smoking is considered a causative factor. Approximately 40% of the patients have a history of inflammation of a vein (phlebitis), which may play a role in the development of Buerger's disease. The disease is mainly seen in the legs of affected persons, but may also appear in their arms. Early symptoms include decrease in the blood supply (arterial ischemia) and superficial (near the skin surface) phlebitis. The main symptom is pain in the affected areas. Onset of the disease is gradual and first occurs in the feet or hands. Inflammation occurs in small and medium-sized arteries and veins near the surface of the limb. In advanced cases, blood vessels in other parts of the body may be affected. There is a progressive decrease in the blood flow to the affected areas. The pulse in arteries of the feet is weak or undetectable. The lack of blood flow can lead to gangrene, which is decay of tissue due to restricted blood supply. A cold sensitivity in the hands, similar to that seen in Raynaud's disease, can develop. In this case, the hands turn color--white, blue, and then red--when exposed to the cold.

Diagnosis

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

There is no effective medication or surgery for this disease. Patients must stop smoking to halt further development of the symptoms. Vasodilators, drugs which increase the diameter of the blood vessels, can be administered, but may not be effective. Exposure of affected areas to heat or cold should be avoided. Trauma to the feet and other affected areas should be avoided and infections must be treated promptly.

Prognosis

The disease is progressive in patients who do not stop smoking. Areas with gangrene must be removed surgically.

Prevention

Smoking is the only known causative agent for this disease and should be avoided.

Key Terms

Gangrene
A decay of the tissue in a part of the body that experiences restricted blood flow.
Inflammation
A local reaction to irritation, injury, or infection characterized by pain, swelling, redness, and occasional loss of function.
Ischemia
A decrease in the blood supply to an area of the body caused by obstruction or constriction of blood vessels.

Phlebitis
Inflammation of a vein.

Further Reading

For Your Information

    Books

  • Berkow, R., Editor-in-Chief. The Merck Manual, 17th ed. Rahway, N.J.: Merck and Co., 1997.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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