Clinical Presentation of Buerger's Disease
Buerger's disease typically presents in young male tobacco smokers under age 45-50 with distal extremity ischemia manifesting as digital gangrene, ischemic ulcers, or claudication, often accompanied by migratory superficial thrombophlebitis. 1
Patient Demographics
- The disease almost exclusively affects young tobacco smokers, with onset typically before age 45-50 years 1, 2
- Predominantly affects males (24 men to 5 women in one series), though women can be affected 3
- Heavy tobacco use is nearly universal, with a mean Brinkman index of 780 (range 150-1,640) 3
- Mean age at disease onset is approximately 38 years (range 21-50) 3
Early Clinical Manifestations
- Migratory superficial thrombophlebitis is a common early finding, characterized by recurrent episodes affecting superficial veins of the extremities 1
- Paresthesias including numbness or tingling in affected digits 1
- Raynaud's phenomenon may be an initial presenting symptom 4
- Episodic pain and coldness in fingers can occur early in the disease course 5
Progressive Ischemic Symptoms
The disease progresses through increasingly severe ischemic manifestations:
- Intermittent claudication affecting the foot or calf (present in 23% at presentation) 3
- Rest pain in affected extremities even without activity (13% at presentation) 1, 3
- Digital ulceration or gangrene of toes or fingers (64% at presentation) 3, 2
- Upper limb involvement including cyanosis, pallor, and gangrene occurs in 84% of patients 3
Distribution Pattern
- Disease characteristically affects small- and medium-sized arteries of distal extremities 1, 5
- Infrapopliteal arterial occlusions are typical, with sparing of proximal vasculature 2
- However, proximal extension can occur: femoral arteries in 25%, iliac arteries in 8%, and abdominal aorta/visceral arteries in 6% of cases 3
- Upper limb involvement is evident in 84% of patients 3
- Large arteries, coronary, cerebral, and visceral circulations are typically spared 2
Imaging Findings
- Arteriography demonstrates pathognomonic "corkscrew," "spider legs," or "tree roots" collateral vessels representing dilated vasa vasorum 1
- These findings are suggestive but not absolutely pathognomonic 1
Associated Findings
- Phlebitis migrans (migratory superficial phlebitis) is recognized in 34% of patients 3
- Recent infection history within 6 weeks may be present, though this is more characteristic of Guillain-Barré syndrome 6
- Severe periodontitis is present in more than half of patients examined for oral conditions 3
Critical Pitfall
Continued smoking is directly linked to disease advancement 1. Disease progression occurs despite treatment if tobacco use continues, and complete abstinence is crucial for disease stabilization 4. Even with smoking cessation, recurrent ischemic episodes can occur in advanced disease 4.