Buerger's disease is an inflammation of the arteries, veins, and nerves in the legs, principally, leading to restricted blood flow. Left untreated, Buerger's disease can lead to gangrene of the affected areas. Buerger's disease is also known as thromboangitis obliterans.
Causes and symptoms
The exact cause of Buerger's disease is not known. It is seen most often in young to middle-aged men (ages 20-40) who are heavy smokers of cigarettes. Cases of this disease in non-smokers are very rare, hence, cigarette smoking is considered a causative factor. Approximately 40% of the patients have a history of inflammation of a vein (phlebitis), which may play a role in the development of Buerger's disease. The disease is mainly seen in the legs of affected persons, but may also appear in their arms. Early symptoms include decrease in the blood supply (arterial ischemia) and superficial (near the skin surface) phlebitis. The main symptom is pain in the affected areas. Onset of the disease is gradual and first occurs in the feet or hands. Inflammation occurs in small and medium-sized arteries and veins near the surface of the limb. In advanced cases, blood vessels in other parts of the body may be affected. There is a progressive decrease in the blood flow to the affected areas. The pulse in arteries of the feet is weak or undetectable. The lack of blood flow can lead to gangrene, which is decay of tissue due to restricted blood supply. A cold sensitivity in the hands, similar to that seen in Raynaud's disease, can develop. In this case, the hands turn color—white, blue, and then red—when exposed to the cold.
Diagnosis is usually made from the clinical symptoms. Patients frequently complain of numbness, tingling, or burning sensations in the affected area before evidence of vascular inflammation becomes apparent.
There is no effective medication or surgery for this disease. Patients must stop smoking to halt further development of the symptoms. Vasodilators, drugs that increase the diameter of the blood vessels, can be administered, but may not be effective. Exposure of affected areas to heat or cold should be avoided. Trauma to the feet and other affected areas should be avoided and infections must be treated promptly.
The disease is progressive in patients who do not stop smoking. Areas with gangrene must be removed surgically.
Smoking is the only known causative agent for this disease and should be avoided.
Berkow, R., ed. The Merck Manual. 17th ed. Rahway, NJ: Merck and Co., 1997.
John T. Lohr, PhD
Gangrene—A decay of the tissue in a part of the body that experiences restricted blood flow.
Inflammation—A local reaction to irritation, injury, or infection characterized by pain, swelling, redness, and occasional loss of function.
Ischemia—A decrease in the blood supply to an area of the body caused by obstruction or constriction of blood vessels.
Phlebitis—Inflammation of a vein.