An Overview of Buerger’s Disease

Blood vessels in your limbs become inflamed, leading to infection

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Buerger’s disease (also known as thromboangiitis obliterans) is a rare condition and type of vasculitis in which inflammation, swelling, and blood clotting occur in the small- and medium-sized arteries and veins surrounding the hands and feet. Over time, this narrowing of the arteries and veins leads to damaged skin tissue, causing infection and in severe cases gangrene or complete tissue death.

Buerger's disease symptoms
Illustration by Brianna Gilmartin, Verywell

In cases of extreme gangrene, this may lead to amputation of the body part affected. Since most cases of Buerger’s disease occur in smokers, it is most prevalent in countries whose residents use tobacco heavily, such as in the Mediterranean, Middle East, and Asia. The disease is named after Leo Buerger, an Austrian American pathologist and surgeon who most accurately identified the condition in 1908 at Mount Sinai in New York City.

Symptoms

Common symptoms of Buerger’s disease include:

  • pale, red, or blue-tinted hands and feet.
  • cold hands or feet.
  • severe pain in hands and feet.
  • pain in the lower arms and legs while at rest due to limited blood supply.
  • pain when walking in the legs, ankles, or feet (most commonly in the arch of the foot).
  • sores or ulcers on the hands and feet that are often painful.
  • lack of blood flow to fingers and toes in cold weather (known as Raynaud’s phenomenon).
  • very rarely, if abdominal (mesenteric) arteries and veins are affected, extreme heaviness and pain in the abdomen, as well as possibly weight loss.

Episodes of Buerger’s disease happens in short periods, with symptoms lasting usually one to four weeks, then temporarily subsiding. The disease presents primarily in males between the ages of 20 to 40 years old. However, incidences of women being diagnosed with the disease are starting to spike, most likely due to increased cigarette smoking among women.

Because Buerger’s disease causes lack of blood flow, symptoms are mainly confined to extremities like the fingers and toes, leaving internal organs untouched.

Causes

Almost all patients diagnosed with Buerger’s disease smoke cigarettes or use other forms of tobacco. While researchers are unclear on the exact link between tobacco and Buerger’s disease, it’s thought that the chemicals in tobacco irritate the lining of the blood vessels, causing inflammation and swelling.

For this reason, those who smoke hand-rolled tobacco are at the greatest risk due to the potency and lack of filtering of the tobacco.

Smokers who smoke at least a pack and a half a day are at the greatest risk of being diagnosed with the disease.

Other, less prevalent causes of Buerger’s disease include genetic predispositions and, in rare cases, an autoimmune disease in which the body attacks healthy tissue for unknown reasons. Long-term chronic gum disease can also lead to Buerger’s disease.

Diagnosis

In order to be properly diagnosed with Buerger’s disease, a number of other diseases that cause limited blood flow are often ruled out first. Your health care provider will do a thorough examination to determine that these other disorders are not the cause of inflammation and swelling in the arteries and veins, as the treatment plans for disorders that are not Buerger’s disease are very different in nature.

In addition to undergoing an exam, patients should supply their health care providers with an up-to-date history of their tobacco use. With this information, health care providers will perform a blood test and possibly an angiography—an imaging technique in which dye is injected to view the blood vessels in the arms and legs via X-ray—though there are also noninvasive test options.

Your health care provider will also likely conduct an Allen test to check the blood flow in the arteries linked to your hand. With this test, you’ll make a tight fist to force the blood out of your hand. Your doctor will then press on the arteries on each side of your wrist to slowly flow blood back into your hand, noting the color of your hand during this process. You’ll then open your hand as your doctor releases the pressure on each artery (doing one at a time).

The Allen test will show how quickly the circulation in your hand returns your skin to its normal color. This will give insight into the health of your arteries, as slow blood flow may indicate Buerger’s disease.

Buerger’s disease may be confused with another form of vasculitis or related disease, such as scleroderma or Takayasu's arteritis. Scleroderma is a rheumatic disease characterized by inflammation and pain in the muscles, joints, and connective tissue. Takayasu’s arteritis is a separate rare disorder that’s classified by inflammation in large arteries, such as the heart and lungs, which then restricts blood flow throughout the body. Both of these conditions have symptoms similar to Buerger’s disease. This makes it important for your health care provider to have your entire health history when trying to pinpoint the correct cause of blood flow issues.

Treatment

The symptoms of Buerger’s disease will only cease when a patient stops smoking or using other forms of tobacco products.

In some cases, quitting tobacco may result in a complete remission of the disease and its side effects.

Medication will not treat Buerger’s disease, but can often help control the symptoms of the disease (though anti-inflammatories and blood thinners have varied degrees of success depending on the patient). More extensive measures such as surgery may be needed to help improve blood flow to certain areas. This includes possible amputation if certain areas of the body have extreme and irreversible tissue death.

However, most patients who stick to smoking cessation will not have to resort to more invasive procedures like surgery. For the rare cases where patients with Buerger’s disease are not smokers, medication may be used to help dilate blood vessels, reduce blood clots, improve blood flow, or even stimulate the growth of new blood vessels (a more recent experimental approach to the disease).

Regular and frequent compression to the arms, legs, and other affected extremities to improve blood flow may also be part of the treatment plan.

Coping

Getting diagnosed with Buerger’s disease can be scary, but patients should take comfort in the fact that quitting smoking and other tobacco products has enormous success rates in halting the disease. Among the other health reasons to stop smoking immediately, avoiding the symptoms and side effects of Buerger’s disease should be top of mind for those thinking about smoking cessation and living a healthier lifestyle. 

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