Buerger’s disease

What is Buerger’s disease?

Buerger’s (Bürger’s) disease, or thromboangiitis obliterans, is a type of vasculitis. It describes the clinical syndrome that is characterized by vascular inflammation with segmental thrombotic occlusions of the small and medium-sized arteries and veins, usually of the distal lower limb but occasionally also involving the upper limbs.

It is different from peripheral arterial disease because it is not caused by plaque buildup that causes narrowing of the artery, but by inflammation of the arterial wall along with the development of clots in the artery.

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What causes Buerger’s disease?

This condition is strongly associated with heavy smoking and its progression depends upon whether tobacco use continues or not. This is the reason why Buerger’s disease is also called smokers’ disease. It typically, but not exclusively, occurs in men.

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What are the symptoms?

The symptoms are generally related to ischaemia, or low blood flow, in a limb. These include rest pain in the feet or toes with burning and numbness, painful leg ulcers or tissue death (gangrene). Intermittent claudication is a rare symptom and, when present, is confined to the foot rather than the calf (and may be erroneously attributed to a musculoskeletal problem).

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How is the diagnosis established?

The diagnosis of Buerger’s disease can be made with reasonable certainty if all of the following criteria apply:

• Onset of symptoms before the age of 45 years
• History of smoking
• Signs of foot or toe ischaemia, involvement of upper limb vessels or migratory superficial thrombophlebitis
• Exclusion of diabetes mellitus, and other atherosclerosis risk factors (dyslipidaemia, hypertension), thrombophilia states, autoimmune disorders
• Exclusion of a proximal source of emboli (from the heart or the aorta)
• Arteriographic findings consistent with the disease, like normal tibial arteries to a point of sudden occlusion and tortuous “corkscrew” collaterals which may reconstitute patent segments of the distal tibial or pedal arteries

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Is there any treatment for Buerger’s disease?

Tobacco abstinence is the cornerstone of the management of Buerger’s disease. Smoking as few as 1 or 2 cigarettes daily, using chewing tobacco, or even using nicotine replacements may keep the disease active.

In patients who manage to quit smoking, the appearance of new lesions and gangrene requiring amputation is unusual.

Treatment with corticosteroids is generally ineffective, while iv administration of Iloprost may have some indications. The use of an antiplatelet drug, like Aspirin, has more convincing evidence.

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