Buerger Disease occurs when your small blood vessels swell, particularly those in your hands and feet. It can cause pain during activity (called claudication) and while resting; numbness, tingling or pale color of the skin in your fingers and toes; and painful open sores that don’t heal (ulcers).
Your health care provider can test for this disease with an Allen test. Your provider presses on the arteries in your wrist and slowly flows blood back through it, watching the color of the skin as it changes.
Symptoms
Symptoms include pain in the hands and feet; clammy or cold skin that turns white or blue when the blood vessels close, especially in response to cold temperatures or stress; and fingers or toes that don’t heal, sometimes leading to gangrene. The disease restricts blood flow to the small and medium blood vessels in your hands and feet, which can lead to clots that keep your tissues from getting enough oxygen. In severe cases, amputation may be necessary.
Buerger’s disease, also called Thromboangiitis Obliterans (TO), usually affects young men who smoke heavily. It can also occur in women and people over 50. But it’s rare in other groups.
Doctors can diagnose Buerger’s by studying your symptoms and medical history, including tobacco use. They might use an X-ray called an angiogram to check the blood flow in your arms and legs. They might also measure the blood pressure in your ankles and arms with a cuff. If one limb has high blood pressure and the other low, this is a sign of poor circulation, which can be due to TO.
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Other blood tests can help doctors rule out other conditions that cause similar symptoms, such as diabetes, a blood-clotting disorder or an autoimmune disease like scleroderma or lupus. A type of ultrasound test called doppler ultrasonography uses sound waves to see how your arteries are doing. A doctor can often perform this in the office.
In some cases, a biopsy of the affected area is needed to confirm the diagnosis. But the doctor will probably avoid biopsy sites near areas of poor circulation because it’s important to have good blood flow for healing.
During treatment, you’ll need to stop smoking and limit your exposure to secondhand smoke. You’ll also need to clean cuts and scrapes carefully. Because of the lack of blood flow to your hands and feet, any infection can be serious. Talk to your doctor about antibiotics.
Diagnosis
Buerger Disease, also called thromboangiitis obliterans, happens when the small and medium blood vessels in your arms and legs are damaged. This restricts oxygenated blood flow and leads to clots. Over time, the lack of blood flow damages and destroys tissue in your hands and feet. This can lead to pain, tingling and changes in skin color. If left untreated, it can lead to gangrene.
It’s not clear what causes this condition, but it is very likely to be a result of using tobacco and chewing tobacco. Chemicals in tobacco can damage the lining of your blood vessels. This may lead to inflammation and a clot that restricts blood flow to your legs and arms.
If you’re diagnosed with this condition, you should stop using tobacco products and chewing tobacco right away. You should also avoid certain chemicals and medications that may make the problem worse. You should also exercise regularly and be careful not to injure your legs or arms. This includes working with vibrating tools and doing strenuous activities. Be sure to check your legs and arms often for cuts, scrapes or other problems that might interfere with blood flow.
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Your doctor can diagnose Buerger Disease by taking a history of your symptoms and checking your arms and legs for a lack of blood flow. Your doctor can also order an X-ray called an angiogram to look at your blood vessels.
Another test to check your blood flow is the Allen test. Your doctor will squeeze your hand into a fist. This will push blood out of the wrist arteries. Then your doctor will release your hand and watch the artery for a quick return of blood flow. If it takes a long time for your hand to return to its normal color, that could be a sign of Buerger Disease.
If your disease gets worse, you may need a surgery to remove infected or dead tissue in your legs and feet (amputation). You may also need medications to improve blood flow to your extremities, such as cilostazol, clopidogrel, pentoxifylline, prostacyclin and medicines that block the action of coagulation enzymes.
Treatment
Buerger disease is a type of vascular disease caused by inflammation (thromboangiitis obliterans). It affects the small- and medium-sized peripheral arteries. It is common among heavy cigarette smokers between the ages of 20 and 45. It is characterized by narrowing of the blood vessels in the extremities and leads to pain (claudication) and ulcers on the fingers and toes. It can also cause tissue death (gangrene) in the affected limbs.
The best treatment for Buerger disease is to quit smoking. However, many patients have difficulty quitting smoking. Other treatments that can help are vasodilators, such as calcium channel blockers, and hyperbaric oxygen therapy. The latter is an effective treatment for diabetes and may improve symptoms in Buerger disease.
Other medications that have been shown to help include iloprost, a drug that increases blood flow to the legs and feet. Some studies show that the drug can slow or stop the progression of Buerger disease to gangrene and save limbs. Some studies show that implantable spinal cord stimulation can decrease rest pain and increase circulation in patients with Buerger disease.
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Surgery is not an option for most people with Buerger disease because of the small caliber of the affected arteries and lack of suitable distal targets or venous conduits. This makes it difficult to perform endovascular or open surgical bypass procedures. Eventually, a significant number of patients develop chronic nonhealing ischemic ulcerations, which lead to gangrene and require major amputation.
The best way to prevent complications from Buerger disease is to quit smoking and avoid other risk factors. Avoid high-fat foods, which can increase your cholesterol and triglycerides. Get regular exercise, especially in the legs and feet, to help improve blood flow. Talk to your health care provider about how much and what types of exercise are safe for you.
Check your skin regularly for cuts and scrapes. Because people with Buerger disease lose feeling in their fingers and toes, injuries may go unnoticed. Be sure to use a vibrating tool with caution, as these can cause blood vessel injuries in the hands and feet.
Prevention
Almost all people who get Buerger disease smoke cigarettes or other tobacco products. This includes cigars, chewing tobacco and marijuana. The disease is more common in people of middle age or older, especially men. It also is more common in people who are of Asian or Middle Eastern descent, but it can happen to anyone.
Buerger disease occurs when blood vessels in the hands and feet swell and restrict blood flow. The lack of blood to the skin and tissue in the affected area causes painful open sores. These sores are slow to heal and may become infected. The condition can cause a serious complication called gangrene. If gangrene develops, it may need to be removed by surgery.
Doctors don’t know what causes Buerger disease. But they do know that smoking or other tobacco use raises your risk. They think that certain chemicals in tobacco irritate the lining of your blood vessels and make them swell. They also think that the swollen blood vessels may trigger your immune system to attack the blood vessels, as if they were bad germs.
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A health care provider can diagnose Buerger disease by checking your pulse and asking questions about your family history. They may do an exam of your hands and feet, looking for any sores that don’t heal. They may also order a test to check for blocked blood vessels in your arms and legs. The test may include an angiogram, in which your doctor inserts a thin tube into an artery and pumps dye through it. The dye shows up on X-rays or a CT scan.
You can prevent Buerger disease by quitting smoking and other tobacco products. Even a few cigarettes a day can make the condition worse. Your doctor can help you quit by suggesting programs and medicines. They can also recommend ways to improve blood flow to your hands and feet. For example, walking more bit by bit each day may help.
If you are diagnosed with Buerger disease, it is important to follow your treatment plan and keep up with your regular visits to your health care provider. Bring a list of all your symptoms, including when they started. Also, bring a list of all the medicines you take, including herbs and vitamins.
