Buerger’s Disease
Buerger’s disease, medically known as thromboangiitis obliterans, is a rare disease affecting the arteries and veins located in the arms and legs. With this condition, your blood vessels swell, inhibiting blood flow and sometimes even leading to blockages from blood clots (thrombi).
Over time, this damages, and in some cases, destroys skin tissues and may lead to infection and gangrene. Symptoms of Buerger’s disease, including pain and inflammation, are usually first experienced in your hands and feet and may eventually affect larger areas of your arms and legs.
The vast majority of those diagnosed with Buerger’s disease smoke cigarettes or use other forms of tobacco, such as chewing tobacco. To avoid this condition and its consequences, you must stop using all forms of tobacco. Otherwise, you are putting yourself at risk for amputation of all or part of a limb.
Symptoms
Symptoms of Buerger’s disease include:
- Intermittent pain in your legs and feet or arms and hands. Pain may occur with activity (called claudication), and subside when you are at rest
- Inflammation of a vein just below the skin’s surface as a result of a blood clot
- Fingers and toes that turn pale and numb (Raynaud’s phenomenon)
- Open, painful sores on fingers and toes
Causes
While tobacco use clearly plays a role in Buerger’s disease, it’s not clear why, and the exact cause of the condition remains unknown.
Experts suspect that some people may be genetically predisposed to the disease. Another possible cause is an autoimmune disorder in which the body’s immune system mistakenly attacks its own healthy tissue.
Risk Factors
Tobacco use
Cigarette smoking, and using oany form of tobacco, including cigars and chewing tobacco, greatly increases your risk of Buerger’s disease. This is especially true of those who smoke hand-rolled cigarettes with raw tobacco.
It is not known why tobacco use increases your risk of Buerger’s disease, but virtually every patient diagnosed uses tobacco in some form. It is thought that the chemicals found in tobacco may irritate the lining of blood vessels, causing them to become inflamed.
Chronic gum disease
Long-term infection of the gums is also linked to the condition.
Sex
Buerger’s disease is much more common in men than in women, but this may be due to higher rates of smoking in males.
Age
Typically, symptoms of the disease first appear in people under 45 years of age.
Diagnosis
While there are no tests which can confirm a diagnosis of Buerger’s disease, tests can be done to confirm the suspicion, as well as rule out other more common conditions with similar symptoms. Tests may include:
Blood tests
Blood tests can reveal certain substances which will help rule out conditions such as lupus, scleroderma, blood-clotting disorders, and diabetes, among others.
The Allen’s test
This test checks how blood flows through your arteries and carries blood to your hands. You will be asked to make a tight fist, forcing blood out of your hand and causing it to lose color. By pressing on the arteries found on either side of your wrist we can slow the return of blood flow back into your hand. When you open your hand and pressure is released on one artery, then the other, we can assess the general health of your arteries by how quickly the color returns to your hand. If this occurs slowly, it may indicate a problem, such as Buerger’s disease.
Angiogram
An angiogram is a process that allows us to see the condition of your arteries. This can be done non-invasively with a CT or MRI scan.
It can also be performed by using a catheter. This procedure entails a special dye injected into the artery, followed by a series of rapid X-rays. If any artery blockages show up on the images, the dye will help to delineate them.
Angiograms may be done for both your arms and legs, even if only one limb shows symptoms. Buerger’s disease almost always affects multiple limbs, so even if you are not experiencing signs and symptoms in your other limbs, this test is essential in detecting early signs of vessel damage which may not yet be physically evident.
Treatment
Smoking cessation
Although no treatment can cure Buerger’s disease, the most effective way to stop progression is to quit using any and all tobacco products. Even in small doses — a few cigarettes a day — can worsen the disease. It makes sense, then, that you will need to avoid nicotine replacement products, as these still release nicotine into your body.
Other treatments
Other treatment approaches do exist but tend to be less effective. These include:
- Medications to dilate blood vessels, dissolve blood clots, and improve blood flow.
- Intermittent compression of the arms and legs to increase circulation in your extremities.
- Stimulation of the spinal cord.
- Surgically severing nerves to the affected area in order to control pain and increase blood flow.
- Medications to stimulate new blood vessel growth.
- Amputation in severe cases of infection or gangrene.