Buerger's Disease

Buerger's disease, also called thromboangiitis obliterans is a rare disease in which the arteries and veins of the arms and legs get blocked. Your blood vessels become

• inflamed,
• swell,
• become blocked with blood clots (thrombi).

This slowly causes damage or destroys your skin tissues, and may lead to infection and gangrene. Buerger's disease usually affects your hands and feet, and may gradually affect larger areas of your arms and legs.

This condition is often associated with heavy use of tobacco, and almost everyone diagnosed with Buerger's disease has the habit of smoking cigarettes or uses other forms of tobacco, such as chewing tobacco.

Quitting all forms of tobacco is the only measure you can take to stop Buerger's disease. As the disease progresses, and in people who do not quit tobacco, amputation of all or part of a limb may be the only option.

The signs and symptoms of Buerger's disease include:

• Fingers and toes that appear red or bluish, pale, and feel cold on touch

• Small painful ulcers on your fingers and toes or other skin changes

• Sudden severe pain in your hands and feet that may come and go. Pain may be burning or tingling.

• Pain in the hands and feet often occurs when at rest, and may get worse during emotional stress

• Pain in the legs, ankles, and feet may occur while walking and go away when you stop that activity (intermittent claudication)

• Inflammation along a vein just below your skin (due to a blood clot in the vein)

When to see a doctor

Make an appointment with your doctor if you think you may have signs or symptoms of Buerger's disease.

The exact cause of Buerger's disease is not clear. While heavy tobacco use clearly plays an important role in the development of Buerger's disease, it is not well understood how it does so.

Experts suspect that there is a genetic predisposition to this disease. It is also suggested that the disease may be caused by an autoimmune response in which the body's immune system attacks its own healthy tissue by mistake.

There are no specific tests for making a diagnosis of Buerger's disease.

You may initially consult your family doctor or primary care provider, who may eventually refer you to someone who specializes in blood vessel diseases (cardiologist).

What you can do

To make the most of your appointment, be prepared with information and questions to ask your doctor.

Write down the symptoms you have including those that may seem unrelated to the reason for your appointment.

Write down key personal information, including whether you smoke, and how many packs a day, or if you have had repetitive trauma on your hands or feet, such as from using a jackhammer or other vibrating tools.
Make a list of all your regular medications, as well as any vitamins or supplements that you take.

Take a family member or friend along with you, if possible. Sometimes, it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Write down questions to ask your doctor

Some basic questions to ask your doctor include:

• What is the most likely cause of my symptoms?
• Are there any other causes for my symptoms?
• Is my condition temporary or long-lasting?
• What treatment options are available, and which one do you recommend?
• How can I best manage my other health conditions together?
• Are there any restrictions that I need to follow?
• Are there any brochures or other printed material that I can take home? What websites do you recommend visiting?

What to expect from your doctor

Your doctor may ask the following questions:

• When did you begin experiencing symptoms?
• Are your symptoms continuous or do they come and go?
• How severe are your symptoms?
• Does anything seem to improve or worsen your symptoms?
• Do you use any form of tobacco or have you used it before?
• Do your fingers get discolored when exposed to cold?
• Have you experienced repetitive trauma to the affected fingers from tools?

Your doctor will order some tests to rule out other more common conditions or confirm suspicion of Buerger's disease caused by your signs and symptoms.

Tests may include:

Blood test

Blood tests to check for certain substances helps to 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, which will check blood flow through the arteries carrying blood to your hands. In the Allen's test, you will asked to hold 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 down the flow of blood back into your hand, thus making your hand lose its normal color.

Then, you can open your hand and your doctor releases the pressure on one artery, then on the other. How quickly your hand regains its normal color will give a general indication about the health of your arteries. Slow blood flow into your hand may be a sign of a problem such as Buerger's disease.

Angiogram

An angiogram may be done to check the condition of your arteries. It is done non-invasively with the use of CT or MRI scans or it may be done by passing a catheter into an artery. A special dye is injected into the artery, after which a series of rapid X-rays are taken. This dye helps to define artery blockages that show up on the images. Your doctor may order angiograms of both your arms and your legs, even if you do not have signs and symptoms of Buerger's disease in all of your limbs.

Buerger's disease often affects more than one limb, so even if you do not have signs and symptoms in your other limb, this test can detect early signs of vessel damage.

The following tests may be done to reveal blockage of blood vessels in the affected hands or feet:

• Ultrasound of the extremities, called plethysmography
• Doppler ultrasound of the extremities

Several treatment methods are used for buerger's disease.

Smoking cessation

The most effective way to stop the disease progression is to quit the use of all tobacco products. Even smoking a few cigarettes a day can aggravate the disease.

Your doctor will counsel you and advise medications that can help you stop smoking. You have to avoid nicotine replacement products as they supply nicotine, which can in turn activate Buerger's disease. Non-nicotine products that you can use are available.

There is another option to help you quit smoking – a residential smoking cessation program. In these programs, you will need to stay at a treatment facility, sometimes a hospital, for a few days or weeks. During this period, daily counseling sessions and other activities will be conducted to help you deal with your cravings for cigarettes and to help you learn to live tobacco-free.

Other treatments

Other treatment approaches exist but may be less effective. Options include:

• Medications that dilate blood vessels (vasodialtors), 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 have not been well-established

• Medications to stimulate the growth of new blood vessels (therapeutic angiogenesis), an approach that is considered experimental

• Amputation, if gangrene occurs

To prevent Buerger's disease, it is important to abstain from the use of tobacco and its products.

Virtually everyone with Buerger's disease has used tobacco in any of its forms, most prominently cigarettes.

Quitting smoking may be difficult. If your attempts to stop smoking have failed in the past, talk to your doctor about strategies to help you quit.

Lifestyle modifications are necessary in order to cope with buerger's disease.

Take special care of your fingers and toes if you have been diagnosed with Buerger's disease.

Carefully check your skin on arms and legs for presence of cuts and scrapes.

Protect your fingers and toes from exposure to extreme cold.

Low blood flow to your extremities decreases your body's resistance to infection. Small cuts and scrapes can easily give rise to serious infections.

Therefore, always clean any cut with

• a soap and water,
• apply antibiotic ointment,
• cover it with a sterile dressing.

Check whether your cuts or scrapes heal normally. If they are getting worse or heal slowly, see your doctor immediately.

Visit your dentist regularly, and maintain your gums and teeth in good health to avoid gum disease, which in its chronic form is related to Buerger's disease.

There are several risks and complications associated with buerger's disease.

Risk factors

• Tobacco use: Cigarette smoking greatly enhances your risk of developing Buerger's disease. This disease can also occur in people who use any form of tobacco, including cigars and chewing tobacco. People who smoke hand-rolled cigarettes that contains raw tobacco are at a greatest risk of Buerger's disease. The chemicals present in tobacco may irritate the lining of your blood vessels, causing them to swell. The incidence of Buerger's disease is highest in areas of the Mediterranean,Middle East Asia where most people are heavy smokers.

• Chronic gum disease: Chronic infection of the gums is also linked to the development of Buerger's disease.
• Gender: Buerger's disease is more common among males than females. However, this predilection may be due to higher rates of smoking among men.
• Age: Buerger's disease often appears in people below the age of 45 years.

Complications

If Buerger's disease worsens, there may be loss of blood flow or decreased flow of blood to your affected fingers and toes.

This is because of the blockages that make it hard for the blood to reach the tips of your fingers and toes. Tissues that do not receive blood are devoid of the oxygen and nutrients they need to survive.

This results in tissue death on the ends of your fingers and toes (gangrene). Signs and symptoms of gangrene include black or bluish skin discoloration, a loss of feeling in the affected finger or toe, and a foul smell emanating from the affected area.

Gangrene is a serious condition that generally requires amputation of the affected fingers or toes.