Buerger’s Disease – Pathophysiology, Causes, and Prevention.

Overview – Buerger’s disease

Buerger’s disease, also called thromboangiitis obliterans, is an inflammation of small- and medium-sized blood vessels. Although any artery can be affected, it usually presents with blockages of the arteries to the feet and hands, leading to pain and tissue damage.

The disease is found worldwide and can affect people of any race and age group. However, it mainly affects Asian and Middle Eastern men between the ages of 40 and 45 who heavily use, or have heavily used, tobacco products, including chewing tobacco.

Pathophysiology of Buerger’s disease

As noted, the development of TAO is strongly associated with the heavy use of tobacco, and the progression of the disease is closely linked to continued use.

A few observations suggest the existence of an immunologic phenomenon leading to vast dysfunction and inflammatory thrombi. Patients with TAO exhibit hypersensitivity to intradermally injected tobacco extracts, increased cellular sensitivity to collagen types I and III, elevated serum anti–endothelial cell antibody titers, and impaired peripheral endothelium-dependent vasorelaxation. They also show a higher prevalence of human leukocyte antigen (HLA)–A9, HLA-A54, and HLA-B5, suggesting a genetic component to the disease.

Causes

The exact cause of Buerger’s disease is not known. Things that increase your risk of getting Buerger’s disease include:

  • Most people with Buerger’s disease smoke cigarettes or use tobacco products.
  • The disease is more common in males.
  • The disease usually appears at 40-45 years of age.

Buerger’s disease risk factors

Tobacco use greatly increases the risk of Buerger’s disease. It is believed that the chemicals in tobacco irritate the lining of your blood vessels and cause them to swell.

Most people who have Buerger’s disease are those who use any form of tobacco, including:

  • Cigarettes
  • Cigars
  • Chewing tobacco

Buerger’s disease is most common among young and middle-aged men who are heavy smokers. Those who smoke more than a pack and a half a day are most at risk for Buerger’s disease.

Buerger’s Disease Symptoms

Usually, the first sign of Buerger’s disease is pain in your hands or feet that spreads to your arms and legs. It may be severe. You can get it when you’re active (called claudication) or resting. It can be worse when you’re cold or stressed.

You might also notice changes in your hands and feet. They may:

  • Feel cold, numb, or tingly
  • Look pale, red, or blue in color
  • Have thin, shiny skin
  • Have less hair than usual
  • Your fingers and toes might:
  • Get painful open sores
  • Turn pale when you’re cold (Raynaud’s phenomenon)

You could also have swelling along a vein just under your skin. This is usually a sign of a blood clot. See your doctor right away.

Possible Complications

Complications include:

  • Tissue death (gangrene)
  • Amputation of fingers or toes
  • Loss of blood flow in the limb of the affected fingers or toes

Diagnosis and Test for Buerger’s disease

While no tests can confirm whether you have Buerger’s disease, your doctor will likely order tests to rule out other more common conditions or confirm suspicion of Buerger’s disease brought on by your signs and symptoms. Tests may include:

Blood tests

Blood tests to look for certain substances can rule out other conditions that may cause similar signs and symptoms. For instance, blood tests can help rule out autoimmune diseases such as scleroderma or lupus, blood-clotting disorders, and diabetes.

The Allen’s test

Your doctor may perform a simple test called the Allen’s test to check blood flow through the arteries carrying blood to your hands. In the Allen’s test, you make 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 the flow of blood back into your hand, making your hand lose its normal color.

Next, you open your hand and your doctor releases the pressure on one artery, then the other. How quickly the color returns to your hand may give a general indication about the health of your arteries. Slow blood flow into your hand may indicate a problem, such as Buerger’s disease.

Angiogram

An angiogram helps to see the condition of your arteries. An angiogram can be done non-invasively with the use of CT or MRI scans.

Or it may be done by threading a catheter into an artery. During this procedure, a special dye is injected into the artery, after which you undergo a series of rapid X-rays. The dye helps make any artery blockages easier to see on the images.

Your doctor may order angiograms of both your arms and your legs — even if you don’t have signs and symptoms of Buerger’s disease in all of your limbs. Buerger’s disease almost always affects more than one limb, so even though you may not have signs and symptoms in your other limbs, this test may detect early signs of vessel damage.

Treatments and drugs

Smoking cessation

Although no treatment can cure Buerger’s disease, the most effective way to halt the disease’s progress is to quit using all tobacco products. Even a few cigarettes a day can worsen the disease.

Your doctor can counsel you and recommend medications to help you stop smoking and stop the swelling in your blood vessels.

Other treatments

Other treatment approaches exist but are less effective. Options include:

  • Medications to dilate blood vessels, 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

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

Amputation, if infection or gangrene occurs

Lifestyle and home remedies

Take care of your fingers and toes if you have Buerger’s disease. Check the skin on your arms and legs daily for cuts and scrapes, keeping in mind that if you’ve lost feeling to a finger or toe you may not feel, for example, a cut when it happens. Keep your fingers and toes protected and avoid exposing them to cold.

Prevention of Buerger’s disease

The following strategies are important for preventing complications:

  • Use of well-fitting protective footwear to prevent foot trauma and thermal or chemical injury
  • Early and aggressive treatment of extremity injuries to protect against infections
  • Avoidance of cold environments
  • Avoidance of drugs that lead to vasoconstriction

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