Definition

Buerger's disease, also known as thromboangiitis obliterans, is an inflammation of the small and medium-sized blood vessels. Buerger's disease can affect any blood vessel, but it typically occurs in vessels in the arms, legs, fingers, and toes. Inflammation in the blood vessels makes it difficult for blood to flow through them, and blood clots can form, leading to blockages in the blood vessels. As a result, you may experience pain and tissue damage from the fingers and toes, which can spread to your limbs.

Buerger's disease is considered a relatively rare vascular condition. It can be found worldwide and affects people of all races and ages. However, it predominantly affects Asian and Middle Eastern men aged 40 to 45 who often use tobacco products, such as smoking and chewing tobacco.

Causes

The exact cause of Buerger's disease is not clearly understood. Research indicates that the disease is associated with smoking or tobacco use, although the exact mechanism of influence is not definitively known. It is believed that chemicals in tobacco can irritate the lining of blood vessels. Additionally, experts speculate that some individuals may have a genetic predisposition to the disease. It is also possible that the disease is caused by an autoimmune response, where the immune system mistakenly attacks healthy tissue.

The progression of Buerger's disease begins with swelling in the medium and small-sized arteries (arteries) and the formation of blood clots in your blood vessels. This condition will decrease the circulation of blood flow to your hands and feet. Over time, this condition can lead to tissue death due to a lack of the nutrition and oxygen that should be delivered by blood.

Risk factor

Several factors that can increase your risk of developing Buerger's disease include:

1. Age

The disease often first appears in people under the age of 45.

2. Gender 

Buerger's disease is much more common in men than in women. This difference may be related to higher smoking rates among men compared to women.

3. Tobacco Use

Smoking greatly increases the risk of Buerger's disease. However, Buerger's disease can occur in people who use all forms of tobacco, not just cigarettes, such as cigars and chewing tobacco. People who smoke hand-rolled cigarettes from raw tobacco and those who smoke more than one and a half packs a day may have the highest risk of Buerger's disease. The highest incidence of Buerger's disease is found in the Mediterranean, Middle East, and Asia, where smoking rates remain high.

4. Chronic Gum Disease

Long-term gum infections have been associated with the development of Buerger's disease, although the basis of this relationship is still unclear.

Symptoms

Symptoms of Buerger's disease typically last for a short period, around one to four weeks, and then subside temporarily. Symptoms of Buerger's disease may include:

• Tingling or numbness in the hands or feet
• Hands or feet become pale, red, or bluish
• Pain that may come and go in your legs and arms
• Pain may occur when you use or move your hands or feet
• The pain subsides when you stop the triggering activity or when you rest
• Inflammation along the veins just under the skin (due to blood clots in the veins)
• Fingers and toes become pale when exposed to cold
• Painful open sores on the fingers and toes

In addition, there are several additional symptoms if Buerger's disease has been present for some time, such as:

• Muscle cramps
• Blood clots in blood vessels
• Red, blue, or pale fingers or toes
• Blue in part of the face
• Cold or numb feet or hands
• Gangrene (tissue death due to lack of oxygen and nutrition supply from blood)
• Skin ulcers

Diagnosis

In diagnosing Buerger's disease, the doctor will begin with an interview. They will inquire about any symptoms you may be experiencing, as well as potential risk factors you may have. Subsequently, a physical examination will be conducted. The doctor will examine the affected areas of your hands or feet to check for any swelling or changes in color.

Essentially, the diagnosis of Buerger's disease can be confirmed based on the interview and physical examination, as the disease has distinct clinical characteristics. However, the doctor may also perform additional tests to rule out other possible conditions. Some of these supplementary tests include:

1. Allen's test

This test is a basic assessment of blood flow. First, you will be asked to tightly clench your hand to push blood out of your hand. Then, the doctor will press on the pulse vessel at your wrist to slow down the blood flow back into your hand. At this point, your hand will become pale. As you open your hand, the doctor will release the pressure on the pulse vessel on one side of your wrist and then on the other side. If it takes a few moments for your hand to return to its normal color, this may be indicative of Buerger's disease.

2. Angiogram

This is a type of X-ray examination to view blocked blood vessels in your arms and legs. The doctor will insert a thin tube called a catheter into your artery. A dye will then be injected into the artery, and an X-ray will be quickly taken to visualize your blood vessels. CT scans or MRI scans can also produce similar images.

3. Blood tests

These tests can help the doctor rule out other possible conditions. The doctor may want to check for conditions such as diabetes, lupus, and disorders that cause blood clotting.

Management

There is no cure for Buerger's disease. However, the most important factor in improving symptoms and preventing progression is to quit smoking and refrain from using other tobacco products. Other therapies that can help improve blood flow and reduce pain include:

Medications to dilate blood vessels or other medications to dissolve blood clots Walking exercise Applying compression or periodic pressure to your arms and legs Surgical procedures to cut nerves in the affected areas (sympathectomy) The doctor may also need to amputate part or all of the affected area on your hands or feet if tissue death occurs.

Complications

Over time, Buerger's disease can slow down and completely stop blood flow to your fingers and toes. This can lead to gangrene, where the skin and tissue on your fingers and toes begin to die. The affected tissue will become numb and turn blue or black. If you have gangrene, the doctor typically needs to amputate the affected body part. In rare cases, Buerger's disease can also lead to stroke or heart attack.

Prevention

The best way to prevent Buerger's disease is to quit smoking and refrain from using other tobacco products such as chewing tobacco.

When to see a doctor?

Consult a doctor if you experience symptoms suggestive of Buerger's disease.

Looking for more information about other diseases? Click here!