Thromboangiitis obliterans

Alternative names
Buerger’s disease

Definition
Thromboangiitis obliterans is a disease that causes obstruction of the blood vessels of the hands and feet.

Causes, incidence, and risk factors

Thromboangiitis obliterans (Buerger’s disease) is caused by vasculitis, which is an inflammation of blood vessels. Inflammation is irritation with presence of extra immune cells.

The blood vessels of the hands and feet are especially affected, becoming constricted or totally blocked. This reduces blood flow to the tissues of hands and feet, resulting in pain and eventually damage.

Thromboangiitis obliterans affects approximately 6 out of every 10,000 people. It almost always affects men 20 to 40 years of age who have a history of smoking or chewing tobacco.

The condition may also be associated with a history of Raynaud’s disease. This disorder is very uncommon in children, but may occur in those with autoimmune diseases.

Symptoms

     
  • Pain in the hands and feet       o Acute, severe       o Burning or tingling       o Often occuring at rest  
  • Pain in the legs, ankles, or feet when walking (intermittent claudication)       o Often located in the arch of the foot  
  • Skin changes or ulcers on hands or feet  
  • Hands or feet may be pale, red, or bluish  
  • Hands or feet may feel cold

Note: Symptoms may worsen with exposure to cold or with emotional stress. Usually, two or more limbs are affected.

Signs and tests
The hands or feet may show enlarged, red, tender blood vessels. Pulse may be decreased or absent in the affected extremity.

Blockage of blood vessels in the extremity may show on:

     
  • An angiography/arteriography of the extremity  
  • A Doppler ultrasound of the extremity

Final confirmation of the diagnosis may require biopsy of the blood vessel.

Treatment

There is no cure for thromboangiitis obliterans. The goal of treatment is to control symptoms.

The patient must stop smoking if the affected extremity is to be saved. Cold temperatures and other conditions that reduce circulation to the extremities should be avoided. Attempts to increase circulation may include applying warmth and gently exercising the affected area.

Surgical sympathectomy (cutting the nerves to the area) may help control pain. Aspirin and vasodilators may also used. Amputation of the extremity may be necessary if infection or extensive tissue death occurs.

Expectations (prognosis)
Symptoms of thromboangiitis obliterans may disappear if the person stops tobacco use. For some, amputation is unavoidable.

Complications

     
  • Gangrene (tissue death)  
  • Loss of circulation beyond the affected extremity  
  • Amputation

Calling your health care provider
Call your health care provider if symptoms indicate thromboangiitis obliterans is present, if symptoms worsen despite treatment, or if new symptoms develop.

Prevention
Those with a history of Raynaud’s disease or thromboangiitis obliterans should avoid all tobacco use.

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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