Buerger’s

Disease
A presentation by Jennifer Kent-Baker
Buerger’s Disease: What It Is

Buerger's disease (thromboangiitis obliterans) is a

rare disease characterized by a combination of
acute inflammation and thrombosis of the arteries
and veins in the hands and feet. The obstruction of
blood vessels in the hands and feet reduces the
availability of blood to the tissues, causes pain and
eventually damages or destroys the tissue. It often
leads skin ulcerations and gangrene of fingers and
toes. Rarely, in advanced stages of the disease, it
may affect vessels in other parts of the body.
 Thromboangiitis obliterans (also known as
Buerger's disease, Buerger disease [English
/bʌrɡər/; German /byrgər/], or presenile
gangrene[1] ) is a recurring progressive
inflammation and thrombosis (clotting) of
small and medium arteries and veins of the
hands and feet. It is strongly associated with
use of tobacco products,[2] primarily from
smoking, but also from smokeless tobacco.
Buerger’s Disease: Appearance
Ulcers and Gangrene caused by Buerger’s Disease
Buerger’s Disease: Who It Affects

Buerger's disease affects approximately six out of

every 10,000 people. It almost always affects men,
ages 20 to 40, who smoke or chew tobacco.
Recently, however, more women and men over the
age of 50 have been diagnosed with Buerger's
disease. This disorder is still very uncommon in
children, but it may occur in those with autoimmune
diseases. Buerger's disease is most common in the
Orient, Southeast Asia, India and the Middle East,
but is rare among African-Americans.
Buerger’s Disease: Symptoms
 Enlarged, red, tender cord-like veins
 Pain or tenderness
 Numbness and tingling in the limbs
 Skin ulcers or gangrene of the digits

 Discoloration
 Two or more limbs affected
 Pain may increase with activity such as walking and decrease
with rest
 Pulse may be decreased or absent in the affected extremity
 Symptoms may worsen with exposure to cold or with emotional
stress
Buerger’s Disease: The Cause

Buerger's disease is greatly associated with

heavy to moderate tobacco use, both
cigarette and smokeless. The disease is an
autoimmune reaction triggered by tobacco.
 patofisiologi
 There are characteristic pathologic findings of acute
inflammation and thrombosis (clotting) of arteries
and veins of the hands and feet (the lower limbs
being more common). The mechanisms underlying
Buerger's disease are still largely unknown, but
smoking and tobacco consumption are major factors
associated with it. It has been suggested that the
tobacco may trigger an immune response in
susceptible persons or it may unmask a clotting
defect, either of which could incite an inflammatory
reaction of the vessel wall.[4] This eventually leads
to vasculitis and ischemic changes in distal parts of
limbs.
diagnosis
 A concrete diagnosis of thromboangiitis
obliterans is often difficult as it relies heavily on
exclusion of other conditions. The commonly
followed diagnostic criteria are outlined below
although the criteria tend to differ slightly from
author to author. Olin (2000) proposes the
following criteria:[6]
Typically between 20–40 years old and male,
although recently females have been
diagnosed.[7]
 Current (or recent) history of tobacco use.
 Presence of distal extremity ischemia (indicated
by claudication, pain at rest, ischemic ulcers or
gangrene) documented by noninvasive vascular
testing such as ultrasound.
 Exclusion of other autoimmune diseases,
hypercoagulable states, and diabetes mellitus by
laboratory tests.
 Exclusion of a proximal source of emboli by
echocardiography and arteriography.
 Consistent arteriographic findings in the
clinically involved and noninvolved limbs.
Buerger’s Disease: Diagnosing
 Buerger's disease is often masked by a wide variety of other
diseases that cause diminished blood flow to the hands and feet,
therefore, other disorders must be ruled out with aggressive
evaluation.

Blockage of blood vessels in the hands and feet caused by

Buerger's disease may be detected by one of the following
methods:

 An angiogram or an arteriogram of the upper and lower

extremities
 A Doppler ultrasound

Skin biopsies are rarely used because of concern that the biopsy
site near an area with poor blood circulation will not heal.
Normal and Abnormal Angiograms
Buerger’s Disease: Angiogram
Angiogram of the Hand

Normal In Buerger’s Disease

Buerger’s Disease: Prevention

To avoid the onset of Buerger's disease,

tobacco use should be avoided, particularly
by men.
Buerger’s Disease: Treatment

 The only method known to be an effective

treatment for Buerger's disease is
immediately quitting smoking. Patients who
continue to smoke after a diagnosis of
Buerger's disease will generally require
amputation of the fingers and toes.

 Since there is no cure for Buerger's disease,

the goal of treatment is to control symptoms.
 Smoking cessation has been shown to slow
the progression of the disease and decrease
the severity of amputation in most patients,
but does not halt the progression.
 Treatment by 100% hyperbaric oxygen.

 In acute cases, drugs and procedures which
cause vasodilation are effective in reducing
pain experienced by patient. For example,
prostaglandins like Limaprost[8] are
vasodilators and give relief of pain, but do not
help in changing the course of disease.
Epidural anesthesia and hyperbaric oxygen
therapy also have vasodilator effect.[1]
 In chronic cases, Lumbar sympathectomy
may be occasionally helpful.[9] It reduces
vasoconstriction and increases blood flow to
limb. It aids in healing and giving relief from
pain of ischemic ulcers.[1] Bypass can
sometimes be helpful in treating limbs with
poor perfusion secondary to this disease.
Use of vascular growth factor and stem cell
injections have been showing promise in
clinical studies
 Debridement is done in necrotic ulcers. In
gangrenous digits, amputation is frequently
required. Above-knee and below-knee
amputation is rarely required.[1]


 Streptokinase has been proposed as

adjuvant therapy in some cases.[10]
 Despite the clear presence of inflammation in
this disorder, anti-inflammatory agents such
as corticosteroids have not been shown to be
beneficial in healing, but do have significant
anti-inflammatory and pain relief qualities in
low dosage intermittent form. Similarly,
strategies of anticoagulation have not proven
effective.
Buerger’s Disease: Symptom Control

 Gentle massage and warmth to increase circulation

 Avoid conditions that reduce circulation to the
extremities
 Avoid sitting or standing in one position for long
periods
 Do not walk barefoot to avoid injury
 Do not wear tight or restrictive clothing
 Report all injuries to physician for appropriate
treatment
Buerger’s Disease: Prognosis
The symptoms of Buerger's disease may
disappear if tobacco use is stopped. If the
affected extremity is to be saved, the patient
must stop smoking. If infection or gangrene
occurs, amputation of the affect extremity
may be necessary.
Some People Just CAN’T Quit!
(Even if it costs an arm & a leg!)