From the Guidelines
Buerger's disease, also known as thromboangiitis obliterans, is a rare inflammatory condition that causes blood vessels in the arms and legs to become blocked, leading to reduced blood flow, and is strongly associated with tobacco use, with nearly all patients being current or former smokers 1.
Definition and Pathophysiology
Buerger's disease primarily affects small and medium-sized arteries and veins, particularly in the hands and feet. The disease process involves inflammation of blood vessel walls, leading to clot formation and eventual blockage, which is why tobacco cessation is so crucial—nicotine causes blood vessel constriction and promotes inflammation, directly worsening the underlying pathology.
Symptoms and Complications
Symptoms include pain in the affected limbs during activity (claudication), coldness, numbness, and tingling in the extremities. In severe cases, tissue damage can occur, leading to ulcers, gangrene, and potentially amputation.
Treatment and Management
The most critical treatment for Buerger's disease is complete tobacco cessation, including avoiding secondhand smoke, as continued tobacco use dramatically worsens the condition and effectiveness of other treatments 1. Additional management includes medications like cilostazol or pentoxifylline to improve blood flow, aspirin to prevent clotting, and calcium channel blockers to dilate blood vessels. Pain management, wound care for ulcers, and infection prevention are also important. In advanced cases, surgical interventions like sympathectomy (cutting nerves to increase blood flow) may be considered, though they have limited success.
Key Recommendations
- Complete tobacco cessation is essential for managing Buerger's disease 1.
- Medications such as cilostazol or pentoxifylline may be used to improve blood flow.
- Aspirin and calcium channel blockers may be used to prevent clotting and dilate blood vessels, respectively.
- Pain management, wound care, and infection prevention are crucial for preventing complications.
From the Research
Definition and Characteristics
- Thromboangiitis obliterans (Buerger's disease) is a systemic vasculitis with predominant development of thrombotic occlusions of small-to-medium diameter arteries of distal portions of both upper and lower limbs 2.
- It is an occlusive, nonatherosclerotic, inflammatory vasculitis that causes ischemia in small and medium vessels 3.
- The disease is characterized by the involvement of the venous bed into the pathological process in the form of migrating thrombophlebitis 2.
Demographics and Risk Factors
- Thromboangiitis obliterans is encountered more often in young adult males, predominantly tobacco smokers 2, 3.
- Approximately 95% of patients are smokers, and disease activity is strongly associated with the use of tobacco 4.
- Women account for 10 to 20% of the patients, and 5 to 10% are more than 60-years-old 4.
Clinical Presentation and Diagnosis
- The clinical pattern is presented by symptoms of increasing insufficiency of blood supply of tissues of extremities 2.
- The diagnosis is made by means of ruling out other vascular diseases (atherosclerosis, diabetes mellitus, systemic diseases of connective tissue, hypercoagulation conditions) based on clinical and laboratory findings, as well as modern methods of visualization 2.
- A Buerger diagnosis requires exclusion of autoimmune, diabetic, and embolic causes 3.
Treatment and Management
- The only recognized treatment for this disease is smoking cessation 3, 5.
- Treatment is aimed at eliminating the aetiological stimulus (i.e., smoking), improving blood circulation by means of regular, dosed physical exercises, and administration of anti-ischaemic agents (analogues of prostaglandins, calcium channel antagonists, antiaggregants and anticoagulants) 2.
- Other treatments that have shown promise include phosphodiesterase type 5 inhibitors 6 and far-infrared therapy 5.