[widget id=”ad_unit-10″]ad_unit-10[/widget]In 1908 Dr. Leo Buerger provided a detailed and accurate description of Thromboangiitis obliterans or Buerger’s Disease (BD) and the pathological findings in 11 amputated limbs.
Thromboangiitis obliterans (Buerger’s Disease) is characterized by segmental, thrombosing (or clotting), and acute and chronic inflammation of intermediate and small arteries and sometimes veins of the extremeties (hands and feet). In many cases it affects the arms as well as the legs. The severity of ischemia (or lack of blood flow) to the distal extremities that occurs in Buerger’s, the disease does not involve other organs.
The typical BD patient is a man (aged 20 to 40) who is a heavy cigarette smoker. BD begins before the age of 35 in most patients. BD appears to be rare among African-Americans.
The association of Buerger’s Disease with tobacco use, particularly cigarette smoking, cannot be overemphasized. The relationship to cigarette smoking is one of the most consistent aspects of this disorder.
Most patients with Buerger’s are heavy smokers, but some cases occur in patients who smoke “moderately”. BD has also been reported in users of smokeless tobacco.
Several theories have been postulated that Buerger’s Disease is:
- an “autoimmune” reaction (the body’s immune system attacks the body’s own tissues) triggered by some constituent of tobacco,
- direct endothelial cell toxicity induced by hypersensitivity to some tobacco products,
- vasoconstriction induced by disturbances in catecholamine metabolism,
- hypercoagulability leading to thrombosis
- NONE OF THESE IS PROVED
Symptoms
- claudication (or pain induced by insufficient blood flow during exercise) in the feet (instep claudication) and/or hands, or pain in these areas at rest.
- The pain typically begins in the extremities but may radiate to other (more central) parts of the body.
Other signs and symptoms of this disease may include
- numbness and/or tingling in the limbs and
- Raynaud’s phenomenon (a condition in which the distal extremities — fingers, toes, hands, feet — turn white upon exposure to cold).
- Skin ulcerations and
- gangrene of the digits (fingers and toes) are common in Buerger’s disease.
- Pain may be very intense in the affected regions.
BD has only one treatment known to be effective – complete smoking cessation. Despite the clear presence of inflammation in this disorder, anti-inflammatory agents such as steroids have not been shown to be beneficial. Similarly, strategies of anticoagulation (thinning of the blood with aspirin or other agents to prevent clots) have not proven effective. The only way to prevent the progression of the disease is to abstain from all tobacco products.
Labs or Test: Certain angiographic (x-ray of blood vessels) findings are diagnostic of Buerger’s. These findings include a “corkscrew” appearance of arteries that result from vascular damage, particularly the arteries in the region of the wrists and ankles.
Angiograms may also show occlusions (blockages) or stenoses (narrowings) in multiple areas of both the arms and legs.
The association of Buerger’s Disease with tobacco use, particularly cigarette smoking, cannot be overemphasized. The relationship to cigarette smoking is one of the most consistent aspects of this disorder.
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