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Buerger Disease

Smoking has strong connection to the disease

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Updated February 27, 2005

Buerger disease, also known as thromboangiitis obliterans, is an inflammatory disease that affects the small- and medium-sized arteries and veins of the arms and legs. Buerger disease causes blood clots to form in these blood vessels. Tobacco use, such as smoking (most individuals) or chewing tobacco, is connected to the onset of Buerger disease and its worsening over time.

The prevalence of Buerger disease has decreased over time as the prevalence of smoking has decreased, and is estimated to affect 12.6-20 individuals per 100,000. The disease is less common in people of northern European descent, and affects more individuals of Indian, Korean, Japanese, and Israeli Ashkenazi Jewish descent. Buerger disease is three times as common in men than in women, and generally affects people less than 45 years old.

Symptoms
Buerger disease causes inflammation and blood clots in the small blood vessels of the arms and legs, and its symptoms come from the reduction (or stoppage) of blood flow:

  • Pain in the arms or legs at rest and/or with movement (claudication)
  • Numbness, tingling, or burning (paresthesia) of the hands and feet
  • Skin breakdown leading to wounds (ulcerations) on the toes, feet, or fingers; these ulcers can become infected, and the tissue can die (gangrene)
  • Hands and feet are cool and mildly swollen
  • More than 80% of individuals have 3-4 limbs affected
  • Swollen, inflamed veins near the skin's surface (thrombophlebitis)
Although Buerger disease typically affects the blood vessels in the extremities, in some individuals larger, internal arteries and veins are affected.

Diagnosis
It can be difficult to make the diagnosis of Buerger disease. Several important factors should be considered, including the individual's age (under 45), current or recent history of smoking or tobacco use, and symptoms such as pain in the arms or legs at rest and the presence of skin ulcers on the hands or feet. No specific laboratory tests exist to confirm or exclude Buerger disease, but many tests can help rule out other disorders with similar symptoms, such as autoimmune diseases, diabetes, or disorders which cause blood clots. Angiography or arteriography can determine if blood clots are present in blood vessels.

Treatment
Completely quitting tobacco use is the only treatment proven to prevent Buerger disease from getting worse. Even smoking just 1 or 2 cigarettes a day, using nicotine gum or patches, or chewing tobacco may continue to cause symptoms. Among individuals with Buerger disease who quit smoking, 94% avoid developing gangrene in their arms or legs to the point that amputation is required. If, however, affected individuals do not quit using tobacco, there is a 43% chance that they will have an amputation within 7-8 years.

To prevent complications from Buerger disease, individuals should take care of their feet, make sure injuries to arms, feet, or legs are treated promptly, and avoid being cold. Antibiotics can treat skin ulcers, and pain medication can relieve arm and leg pain, because even after quitting smoking individuals may continue to have pain.

Information for this article was taken from:
Hanly, E.J., Carpenter, M., Cohn, E.J., & Peyton, B.D. (2004). Buerger disease (thromboangiitis obliterans). eMedicine. accessed at http://www.emedicine.com/med/topic253.htm

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