Buerger’s Disease

Buerger’s disease, also called thromboangiitis obliterans or presenile spontaneous gangrene, is a rare disease of the blood vessels in the arms and legs. The recurring condition usually leads to ulcers, gangrene and, in many cases, limb amputation. It has been strongly associated with smoking cigarettes. 

Symptoms

First reported by Austrian physician Felix Von Winiwarter in 1879, Buerger’s disease causes swelling in the arteries and veins of the arms and legs that eventually blocks the blood flow to those body parts. The condition is often characterized by pain in your feet and legs and/or in your arms and hands. The pain is usually intermittent and most often eases when you stop physical activity (claudication). Thromboangiitis obliterans may also cause inflammation in the limbs, thrombosis (blood clots) that create lumps in the veins, and fingers and toes that turn pale when exposed to cold temperatures (Raynaud’s phenomenon). The condition may also lead to painful, open sores on your fingers and toes that don’t seem to heal. 

The reduction of blood flow associated with Buerger’s disease creates a situation in which the tissue in your arms, legs, hands and feet doesn’t get enough oxygen and nutrients to survive. This creates the initial pain in the limbs and eventually leads gangrene, which must be eliminated via limb amputation. 

Causes

Doctors have been unable to determine a solid cause of thromboangiitis obliterans, but it has been strongly linked to smoking cigarettes, smoking cigars and chewing tobacco. Virtually all patients diagnosed with Buerger’s disease are smokers, with those who smoke hand-rolled cigarettes filled with raw tobacco at the greatest risk of developing the disease. 

It is unclear how smoking cigarettes and using tobacco products increases your chance of developing thromboangiitis obliterans, but some doctors believe that the chemicals in tobacco products may irritate the lining of the blood vessels, causing vasculitis (swelling and inflammation). Smoking and chewing tobacco may also trigger an immune response or unmask thrombosis issues.  

Buerger’s disease is most common in Middle Eastern and Far East countries, where heavy smoking is common. 

According to medical sites like Medline Plus and Maya Clinic, another possible cause of Buerger’s disease is long-term infection of the gums, though doctors are unsure why this leads to the condition, as well. 

Treatment

Because virtually all cases of Buerger’s disease have been linked to the use of tobacco products, it is strongly suggested that anyone diagnosed with the condition quit smoking and/or chewing tobacco immediately. While doing so will not halt the progression of the permanent disease, it can help slow its progression. 

In order to diagnose Buerger’s disease, most doctors will preform an angiogram, which is a special X-ray to determine blood flow in an artery. Once thromboangiitis obliterans is diagnosed, drugs and procedures which cause vasodilation may be used to help with acute cases of the disease, while chronic cases are sometimes treated with Lumbar sympathectomy (the surgical cutting of a sympathetic nerve that reduces vasoconstriction and increases blood flow). 

Unfortunately, most cases of Buerger’s disease lead to gangrene in the fingers and toes, which must be removed via amputation. However, proper management (cessation of smoking and using anti-inflammatory agents) can help prevent entire amputation of the extremities.