This disease was first reported by Buerger in 1908, who described a disease in which the characteristic pathologic findings - acute inflammation and thrombosis (clotting) of arteries and veins - affected the hands and feet.
Buerger's disease, also known as thromboangiitis obliterans, is an inflammatory, nonatheromatous occlusive condition that causes segmental lesions and subsequent thrombus formation in the small and medium arteries (and sometimes the veins), resulting in decreased blood flow to the feet and legs. It may produce ulceration and, eventually, gangrene.
CausesAlthough the cause of Buerger's disease is unknown, a definite link exists to smoking, suggesting a hypersensitivity reaction to nicotine. Incidence is highest among men of Jewish ancestry, ages 20 to 40, who smoke heavily.
Signs and symptoms
Buerger's disease typically produces intermittent claudication of the instep, which is aggravated by exercise and relieved by rest. During exposure to low temperatures, the feet initially become cold, cyanotic, and numb; later,they redden, become hot, and tingle. Occasionally, Buerger's disease also affects the hands, possibly resulting in painful fingertip ulcerations.
Associated signs and symptoms may include impaired peripheral pulses, migratory superficial thrombophlebitis and, in later stages, ulceration, muscle atrophy, and gangrene.
Patient history and physical examination strongly suggest Buerger's disease. Supportive diagnostic tests include:
Therapy may include an exercise program that uses gravity to fill and drain the blood vessels or, in severe disease, a lumbar sympathectomy to increase blood supply to the skin. Amputation may be necessary for nonhealing ulcers, intractable pain, or gangrene.
Treatment is focused on removing all factors that may reduce blood supply:
Smoking is the only known causative agent for this disease and should be avoided.
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