Alternate Names: Buerger's disease

Causes and Risks:

Vasculitis (an aggressive form of inflammation) targets the lining of the small arteries and veins, causing thromboangiitis obliterans (Buerger’s disease). The blood vessels of the hands and feet become constricted or totally obstructed because of the inflammation and clots. This reduces the availability of blood to the tissues, causing pain and eventually damaging or destroying the tissues, and making them more prone to infections and gangrene.

Thromboangiitis obliterans affects approximately 6 out of 10,000 people. It almost always affects men, 20 to 40 years old, who have a history of smoking or chewing tobacco. This may also be associated with a history of Raynaud’s disease. This disorder is very uncommon in children, but it may occur in those with autoimmune diseases.

Prevention: Men with a history of Raynaud’s disease or thromboangiitis obliterans should avoid all tobacco use.

Symptoms:

• Pain or tenderness in the hands and feet
  • Acute, severe
  • Burning, numbness, tingling
  • Often occurs at rest
• Pain in the legs, ankles, or feet(intermittent claudication)
  • Often located in the arch of the foot
  • Increased with activity, decreased with rest
• Skin changes or ulcers in hands or feet
• Hand or foot may be pale or red or bluish
• Hand or foot may feel cold

Note: Symptoms may worsen with exposure to cold or with emotional stress. Usually, two or more limbs are affected.

Signs and Tests:

The hands or feet may show visible enlarged, red, tender cord-like veins. Pulse may be decreased or absent in the affected extremity.

Blockage of blood vessels in the extremity may show on:

• An angiography/arteriography of the extremity
• A Doppler ultrasound of the extremity

Final confirmation of the diagnosis may require biopsy of the blood vessel.

Treatment:

There is no cure. The goal of treatment is control of symptoms.

The affected person MUST stop smoking, if the affected extremity is to be saved. Avoid all conditions that reduce circulation to the extremities including cold temperatures. Attempt to increase circulation may include warmth and gentle exercise.

Surgical sympathectomy (cutting the nerves to the area) may help to control pain. Aspirin and vasodilators are also used. Amputation of the extremity may be necessary if infection or gangrene occurs.

Prognosis: Symptoms of thromboangiitis obliterans may disappear, if the person stops tobacco use. For some, amputation is unavoidable.

Complications:

• Gangrene (tissue death)
• Loss of circulation past the affected extremity

Call your health care provider if symptoms indicate Buerger’s disease is present, if symptoms worsen despite treatment, or if new symptoms develop.