Thromboangiitis obliterans

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 28, 2016
StartDiseasesThromboangiitis obliterans

Buerger's disease (thromboangitis obliterans) is a rare condition affecting the arteries and veins in a person's arms or legs. Specifically, the blood vessels become inflamed, swollen, and may get blocked by blood clots.

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Definition & Facts

According to the New England Journal of Medicine, Buerger's disease affects 12.6 per 100,000 people, and is more common in the Middle East and Asia than other parts of the world. It affects people under the age of 45 more commonly than other demographics, and men are at a higher risk of developing this than women. Smoking is the main cause of the disease though gum disease and genetic factors may also play a causal role.

The disease is named after Leo Buerger, an Austrian-American doctor who identified the condition among amputees in a 1908 article in the American Journal of Medical Science. It is a disease that can lead to serious complications such as gangrene. While there is no cure for this condition, treatment can stop the progression of the disease.

Symptoms & Complaints

Buerger's disease has several signs and symptoms. The condition can cause pain in a person's hands and feet or arms and legs. The pain may occur when a person uses her hands and feet and cease when she stops the activity or rests. The disease usually starts in the hands and feet and affects the arms and legs as it progresses.

In addition, fingers and toes may lose their color and become pale when they are exposed to the cold (Raynaud's phenomenon). The veins under the skin may also be inflamed due to the presence of blood clots. A patient with Buerger's disease may also get painful open sores on their fingers and toes.

Buerger's disease can lead to serious complications. If the condition progresses, blood flow to the fingers and toes decreases due to blockages that make it difficult for blood to reach the tips of the fingers and toes. Tissues that don't get blood cannot receive the nutrients and oxygen they need to survive, and gangrene can set in.

Gangrene occurs when skin tissue dies. Symptoms of gangrene include a loss of feeling in the affected area, blue or black skin, and a foul smell originating from the affected area. Gangrene is a serious condition, and amputation of the affected area is usually required.

Causes

The cause of Buerger's disease isn't known. However, experts know that tobacco use plays a role in the development of the disease. Nearly everyone diagnosed with the condition smokes cigarettes or uses other tobacco products, such as chewing tobacco. Though experts don't know the role tobacco plays in the development of Buerger's disease, they think that the chemicals in tobacco may irritate the lining of blood vessels, leading them to swell. Buerger's disease is far more prevalent in men than in women. This difference may be due to the fact that more men than women smoke.

Experts also suspect that some individuals have a genetic predisposition to developing the disease. It is also thought that Buerger's disease could be caused by an autoimmune response in which the body attacks healthy tissue. In addition, research has found that long-term gum disease is linked to the development of the condition.

Diagnosis & Tests

There are no specific tests that can confirm a diagnosis of Buerger's disease. However, a doctor can order tests to rule out other conditions that cause similar symptoms. The results of these tests may support a diagnosis of Buerger's disease. For example, blood tests can be used to rule out conditions that cause symptoms similar to Buerger's disease, such as diabetes, lupus, scleroderma, and blood-clotting disorders.

A physician can also perform the Allen test to check how well blood is flowing to the hands. For this test, the patient makes a tight fist, forcing the blood out of the hand. Then, the physician presses on the arteries on both sides of the patient's wrist, which slows the blood flow back into the hand and makes the skin lose its normal color. Finally, the patient releases the fist, and the physician releases the pressure on one artery at a time. How fast the blood flows back into the hand can give a general indication of how healthy the arteries are. Slow blood flow into the hand indicates a problem, such as Buerger's disease.

An angiogram may also be performed to determine the condition of a patient's arteries. In an angiogram, a thin tube called a catheter is threaded into an artery. The physician conducting the test inserts contrast dye into the artery, and X-rays are taken. The X-rays show the presence or absence of blood clots in the artery. If blood clots are found, the physician can inject a medication into the artery to dissolve them.

A doctor may order angiograms on both arms and legs even when a patient isn't exhibiting symptoms in all of his limbs. Buerger's disease almost always affects more than one limb. An angiogram may detect early signs of the disease in the other limbs.

Treatment & Therapy

There is no cure for Buerger's disease; however, patients can halt the disease's progress by quitting the use of all tobacco products. Even smoking a few cigarettes each day can make the condition worse. Patients need to work with their doctors to find an effective way to quit smoking. People with Buerger's disease shouldn't use nicotine replacement patches, as nicotine activates the condition.

Non-nicotine products are available to help people quit smoking. Additionally, residential treatment centers can help people stop smoking. In these programs, people participate in daily psychotherapy sessions and other activities to help them deal with cravings and work on any underlying issues that led them to smoking in the first place.

Other treatment options for Buerger's disease exist, but they are not as effective as smoking cessation. For instance, medications can be given to improve blood flow, dissolve blood clots (thrombolytic drug), or dilate blood vessels. Medications to encourage the growth of new blood vessels may also be helpful in the treatment of this condition. However, this approach is considered experimental.

Intermittent pressure to the arms and legs may increase blood flow to the extremities. Amputation of fingers, toes, arms, or legs may be required if severe infection or gangrene occurs. Finally, patients with Buerger's disease can have surgery to cut the nerves to the affected area in order to increase blood flow and to reduce pain. However, this approach is controversial, and its long-term effects aren't well-known.

Prevention & Prophylaxis

The best way to prevent Buerger's disease is by avoiding the use of all tobacco products including cigarettes, cigars, and chewing tobacco.

Buerger's disease can cause some serious complications for those who develop it. With a proper diagnosis and treatment, however, the condition can be managed effectively.