Buerger's disease

Alternative names

Thromboangiitis obliterans

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.