Buerger’s disease

What is Buerger’s disease

Buerger’s disease also known as thromboangiitis obliterans, is a rare inflammatory disease of the arteries and veins in the hands and feet. In Buerger’s disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi). Buerger disease is one of many types of vasculitis (inflammation of small and medium size blood vessels). Buerger’s disease usually first shows in your hands and feet and may eventually affect larger areas of your arms and legs.

When blood doesn’t flow well to your hands and feet, especially during activity, you may have pain and tissue damage. In the worst cases, sores (ulcers) appear on your fingers and toes due to poor circulation to the skin and tissue. The ulcers can become infected and cause gangrene. In a small number of people, Buerger disease reduces blood flow to the heart, belly, or brain.

Virtually everyone diagnosed with Buerger’s disease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop Buerger’s disease. For those who don’t quit, amputation of all or part of a limb is sometimes necessary.

Buerger’s disease complications

If Buerger’s disease worsens, blood flow to your arms and legs decreases. This is due to blockages that make it hard for blood to reach the tips of your fingers and toes. Tissues that don’t receive blood don’t get the oxygen and nutrients they need to survive.

This can cause the skin and tissue on the ends of your fingers and toes to die (gangrene). Signs and symptoms of gangrene include black or blue skin, a loss of feeling in the affected finger or toe, and a foul smell from the affected area. Gangrene is a serious condition that usually requires amputation of the affected finger or toe.

Buerger’s disease symptoms

Buerger’s disease symptoms include:

  • Pain, tenderness or burning feeling that may come and go in your legs and feet or in your arms and hands. This pain may occur when you use your hands or feet when walking and eases when you stop that activity (claudication), or when you’re at rest
  • Inflammation along a vein just below the skin’s surface (due to a blood clot in the vein)
  • Fingers and toes that turn pale, redness, and sometimes bluish in color when exposed to cold (Raynaud’s phenomenon)
  • Painful open sores or ulcers on your fingers and toes
  • Pain or tenderness in your hands or forearms
  • Blood clots

Buerger’s disease causes

The exact cause of Buerger’s disease is unknown. While tobacco use clearly plays a role in the development of Buerger’s disease, it’s not clear how it does so.

People at the greatest risk for Buerger disease are those who are heavy smokers. Men of Asian or Eastern European descent, who are between ages 20 and 40 seem to be especially at risk. Buerger’s disease has also been identified in cigar smokers, marijuana users, and those who use smokeless tobacco such as chewing tobacco and snuff. Buerger’s disease is a rare disorder, especially in countries where the use of tobacco has declined.

Experts suspect that some people may have a genetic predisposition to the disease. It’s also possible that the disease is caused by an autoimmune response in which the body’s immune system mistakenly attacks healthy tissue.

Risk factors for developing Buerger’s disease

Tobacco use

Cigarette smoking greatly increases your risk of Buerger’s disease. But Buerger’s disease can occur in people who use any form of tobacco, including cigars and chewing tobacco. People who smoke hand-rolled cigarettes using raw tobacco may have the greatest risk of Buerger’s disease.

It isn’t clear how tobacco use increases your risk of Buerger’s disease, but virtually everyone diagnosed with Buerger’s disease uses tobacco. It’s thought that chemicals in tobacco may irritate the lining of your blood vessels, causing them to swell. The rates of Buerger’s disease are highest in areas of the Mediterranean, Middle East and Asia where heavy smoking is most common.

Chronic gum disease

Long-term infection of the gums also is linked to the development of Buerger’s disease.

Sex

Buerger’s disease is far more common in males than in females. However, this difference may be linked to higher rates of smoking in men.

Age

The disease often first appears in people less than 45 years old.

Buerger’s disease prevention

Quit using tobacco in any form. Virtually everyone who has Buerger’s disease has used tobacco in some form, most prominently cigarettes. To prevent Buerger’s disease, it’s important to not use tobacco.

Quitting smoking can be hard. If you’re like most people who smoke, you’ve probably tried to quit in the past. It’s never too late to try again. Talk to your doctor about strategies to help you quit.

Buerger’s disease diagnosis

While no tests can confirm whether you have Buerger’s disease, your doctor will likely order tests to rule out other more common conditions or confirm suspicion of Buerger’s disease brought on by your signs and symptoms. Tests may include:

Blood tests

Blood tests to look for certain substances can rule out other conditions that may cause similar signs and symptoms. For instance, blood tests can help rule out scleroderma, lupus, blood-clotting disorders and diabetes, along with other diseases and conditions.

The Allen’s test

Your doctor may perform a simple test called the Allen’s test to check blood flow through the arteries carrying blood to your hands. In the Allen’s test, you make a tight fist, which forces the blood out of your hand. Your doctor presses on the arteries at each side of your wrist to slow the flow of blood back into your hand, making your hand lose its normal color.

Next, you open your hand and your doctor releases the pressure on one artery, then the other. How quickly the color returns to your hand may give a general indication about the health of your arteries. Slow blood flow into your hand may indicate a problem, such as Buerger’s disease.

Angiogram

An angiogram helps to see the condition of your arteries. An angiogram can be done non-invasively with the use of CT or MRI scans.

Or it may be done by threading a catheter into an artery. During this procedure, a special dye is injected into the artery, after which you undergo a series of rapid X-rays. The dye helps to delineate any artery blockages that show up on the images.

Your doctor may order angiograms of both your arms and your legs — even if you don’t have signs and symptoms of Buerger’s disease in all of your limbs. Buerger’s disease almost always affects more than one limb, so even though you may not have signs and symptoms in your other limbs, this test may detect early signs of vessel damage.

Buerger’s disease treatment

There is no cure for Buerger’s disease. Treatment may depend on how far your disease has progressed. It will focus on trying to improve blood flow to the affected area or to reduce pain. Choices include:

  • Stopping all smoking and other forms of tobacco use, including electronic cigarettes.
  • Having surgery to bring blood to the affected tissues
  • Other types of surgery to cut the nerves to the tissue to reduce pain or treat damaged extremities

Some medicines help to relax the blood vessels and improve blood flow to the tissue.

Smoking cessation

Although no treatment can cure Buerger’s disease, the most effective way to halt the disease’s progress is to quit using all tobacco products. Even a few cigarettes a day can worsen the disease.

Your doctor can counsel you and recommend medications to help you stop smoking and stop the swelling in your blood vessels. You’ll need to avoid nicotine replacement products because they supply nicotine, which activates Buerger’s disease; there are non-nicotine products that you can use. If the disease is still active, your doctor may check your urine for the presence of nicotine to see if you’re still smoking.

Another option is a residential smoking cessation program. In these programs, you stay at a treatment facility, sometimes a hospital, for a set number of days or weeks. During that time you participate in daily counseling sessions and other activities to help you deal with the cravings for cigarettes and to help you learn to live tobacco-free.

Other treatments

Other treatment approaches exist but are less effective. Options include:

  • Medications to dilate blood vessels, improve blood flow or dissolve blood clots
  • Intermittent compression of the arms and legs to increase blood flow to your extremities
  • Spinal cord stimulation
  • Surgery to cut the nerves to the affected area (surgical sympathectomy) to control pain and increase blood flow, although this procedure is controversial and long-term results haven’t been well-studied
  • Medications to stimulate growth of new blood vessels (therapeutic angiogenesis), an approach that is considered experimental
  • Amputation, if infection or gangrene occurs

Lifestyle and home remedies

Take care of your fingers and toes if you have Buerger’s disease. Check the skin on your arms and legs daily for cuts and scrapes, keeping in mind that if you’ve lost feeling to a finger or toe you may not feel, for example, a cut when it happens. Keep your fingers and toes protected and avoid exposing them to cold.

Low blood flow to your extremities means your body can’t resist infection as easily. Small cuts and scrapes can easily turn into serious infections.

Clean any cut with soap and water, apply antibiotic ointment, and cover it with a clean bandage. Keep an eye on any cuts or scrapes to make sure they’re healing. If they get worse or heal slowly, see your doctor promptly.

Visit your dentist regularly to keep your gums and teeth in good health and avoid gum disease, which in its chronic form is linked to Buerger’s disease.