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Buerger's disease (also known as thromboangiitis obliterans) is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. It is strongly associated with use of tobacco products, primarily from smoking, but also from smokeless tobacco. This should not be confused with Berger's disease, an unrelated condition.
Features
There is an acute inflammation and thrombosis of arteries and veins of the hands and feet. The main symptom is pain in the affected areas. Ulcerations and gangrene in the extremities are common complications, often resulting in the need for amputation of the involved extremity.
Diagnosis
A concrete diagnosis of thromboangiitis obliterans is often difficult as it relies heavily on exclusion of the conditions. The commonly followed diagnostic criteria are below although the criteria tend to differ slightly from author to author. Olin (2000) proposes the following criteria:
- Age younger than 45 years
- Current (Or recent) history of tobacco use
- Presence of distal extremity ischemia (indicated by claudication, pain at rest, ischemic ulcers or gangrene) documented by noninvasive vascular testing such as ultrasound
- Exclusion of autoimmune diseases, hypercoagulable states, and diabetes mellitus by laboratory tests.
- Exclusion of a proximal source of emboli by echocardiography and arteriography
- Consistent arteriographic findings in the clinically involved and noninvolved limbs.
Pathophysiology
There are characteristic pathologic findings of acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet (the lower limbs being more common). The mechanisms underlying Buerger's disease are still largely unknown. It is suspected that immunological reactions play a role.
Treatment
Immediate and absolute cessation of tobacco use is necessary to prevent any further progression of the disease. Even a few cigarettes a day or nicotine replacements can keep the disease active. Vascular surgery can sometimes be helpful in treating limbs with poor perfusion secondary to this disease.
Prognosis
Buerger's disease is rarely fatal, but amputation is common in patients who continue to use tobacco. It often leads to vascular insufficiency.
Prevention
The disease occurs exclusively in tobacco users, so not using tobacco prevents you from getting the disease. Diet has no influence.
Epidemiology
Prevalence of the disease has decreased where the prevalence of smoking has decreased. It is more common among men. It is more common in Israel, Japan and India than in the United States and Europe. The disease is most common among South Asians, who smoke special cigarettes made of raw tobacco (bidi).
History
Buerger's disease was first reported by physician Leo Buerger in 1908.
References
- Buerger L. Thrombo-angiitis obliterans: a study of the vascular lesions leading to presenile spontaneous gangrene. Am J Med Sci 1908;136:567-80.
- Cotran R, Kumar V, Robbins S, eds: Robbins pathologic basis of disease. 6th ed. Philadelphia: WB Saunders Co; 1999:523.
- Olin JW. Thromboangiitis obliterans (Buerger's disease). N Engl J Med 2000;343:864-9. PMID 10995867.
External link
Cardiovascular diseases | Angiology
מחלת בירגר | 閉塞性血栓性血管炎 | Choroba Bürgera | Morbus Buerger | 血栓闭塞性脉管炎
"Buerger's disease"