Buerger’s Disease

Overview

Also known as Thromboangiitis obliterans (TAO), Buerger’s disease is fairly rare, affecting anywhere from eight to eleven in every 100,000 North Americans or every six out of 10,000 people, depending on the type of reporting. TAO causes blockage of the blood vessels (typically of the arteries) of the hands and feet. TAO may also cause thrombophlebitis (inflammation of the veins).

Possible Causes

Buerger’s disease is caused by vasculitis, which is an inflammation of blood vessels. This disease is most common in men between the ages of 20 and 40 who use tobacco.

Symptoms

The inflammation caused by Buerger’s disease frequently leads to blocked arteries in the lower parts of the arms and legs, and may lead to intermittent claudication – pain that occurs when a person walks. Patients with Buerger’s disease typically complain of foot claudication rather than calf claudication. For more information, please see the page on intermittent claudication. In advanced cases, Buerger’s disease may cause rest pain, which is pain in the limbs due to lack of blood flow that occurs either when the patient sleeps (nocturnal rest pain) or constantly. People with Buerger’s disease may also experience persistent sores or ulcers, a condition known as Critical Limb Ischemia. A patient with Buerger’s disease may even develop gangrene of digits (dead fingers or toes).

Other symptoms may include:

  • Numbness and tingling in the feet and hands
  • Pain or tenderness in the calves, feet, or toes
  • Pain may increase with activity such as walking
  • Clammy and cold skin
  • A diminished sense of heat and cold
  • Skin ulcers or gangrenous (dead) fingers or toes
  • Decreased or absent pulse in affected extremity
Diagnosis

The symptoms of Buerger’s disease may overlap with the symptoms of other vascular diseases. Because of this, more common disorders must be ruled out first. Obstruction of blood vessels in the hands and feet caused by Buerger’s disease may be detected by one of the following diagnostic tests:

  • Angiogram (or arteriogram) of the upper or lower extremities
  • Doppler ultrasound

Such diagnostic tests can help to rule out the possibility of atherosclerosis, a different vascular disease in which the blood vessels degenerate. Atherosclerosis is a much more common cause of obstructed arteries.

Skin biopsies are not typically used to diagnose Buerger’s disease because of concern that a biopsy site near an area with poor blood circulation will not heal.

Treatment Options

There is no cure for Buerger’s disease, though symptoms, such as pain and ulcers, can sometimes be helped. If an affected person smokes, that person should immediately stop smoking, as that typically will stabilize or improve the condition. If someone with Buerger’s disease continues to smoke, that person will generally require amputation of the fingers and toes and may require amputation of both feet and hands. If a person stops smoking but continues to have symptoms—particularly claudication, rest pain, or tissue ulceration—there are some medications which may be beneficial:

  • Blood thinners such as Aspirin or Plavix
  • Pentoxyphylline (decreases viscosity of blood)
  • Pletal (vasodilator)

Exercise is also important for patients with Buerger’s disease.