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Clinical Services at Rush Types of Vasculitis

Buerger's disease (BGD)

What is the cause of Buerger’s disease?
What are the symptoms of Buerger’s disease?
How is the diagnosis of Buerger’s disease made?
What is the treatment for Buerger’s disease?
What is the prognosis for Buerger’s disease?


Buerger’s disease (BGD) (thromboangiitis obliterans) is a progressive disease in which blood vessels to the hands and feet become blocked due to inflammation and thrombosis (clotting). People who are diagnosed with this disease almost always have a history of tobacco use, both with smoking and also smokeless tobacco.

The disease is named for Leo Buerger, the physician who provided the first accurate pathological description at Mount Sinai Hospital in New York City in 1908.

Men comprise about 90 percent of Buerger's disease patients. Most of them are 20 to 40 years old and have a history of heavy smoking or tobacco chewing. This disease is more common in Japan and India than in the United States and Europe, and is most common among South Asians.

What is the cause of Buerger’s disease?

The cause of Buerger’s disease is unknown, but it may be an autoimmune disorder. It is possible that something in tobacco triggers the immune system to attack the body’s blood vessels.

What are the symptoms of Buerger’s disease?

  • Hands or feet may be pale, red or bluish (Raynaud’s phenomenon)
  • Hands or feet may feel cold
  • Severe pain in hands and feet, often occurring at rest
  • Pain in legs, ankles or feet when walking
  • Skin changes or ulcers on hands or feet

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

How is the diagnosis of Buerger’s disease made?

The hands or feet may have large, red, tender blood vessels. The pulse in the affected hands or feet may be low or missing.

The following tests may show blockage of blood vessels in the affected hands or feet:

  • Angiography/arteriography
  • Ultrasound
  • Blood tests for other causes of vasculitis and inflammation

As with other types of vasculitis, a concrete diagnosis of BGD relies heavily on the exclusion of other conditions.

Angiograms of the upper and lower extremities can be helpful in making the diagnosis. Arteries supplying the wrists and ankles may show a “corkscrew” appearance. Angiograms may also show multiple blocked or constricted blood vessels in both the arms and legs. To rule out other forms of vasculitis, it is sometimes necessary to perform angiograms of other body regions not normally affected by Buerger’s disease.

What is the treatment for Buerger’s disease?

While quitting smoking or the use of tobacco products does not stop the disease, it can slow its progression and in some cases moderate the need for amputations.

Vascular surgery can sometimes be helpful in restoring blood flow to affected limbs.

  • There is no cure for Buerger’s disease, but its symptoms can be controlled.
  • Stop using tobacco products of any type.
  • Avoid cold temperatures and other conditions that reduce circulation to the hands and feet.
  • Apply warmth and exercise gently to help increase circulation to the extremities.
  • Cutting the nerves to the area may help control pain.
  • Aspirin and vasodilators may also be used. It may be necessary to amputate the hand or foot if infection or widespread tissue death occurs.

What is the prognosis for Buerger’s disease?

Buerger's is not imminently fatal but shortens the patient’s life span. Ulcerations in fingers and toes may lead to amputations, with amputations of entire limbs almost twice as common in patients who continue to smoke. Female patients generally live much longer than men with the disease.

While intermittent low doses of anti-inflammatory medications such as corticosteroids can provide pain relief, the only way to slow the disease is to stop using all tobacco products.
 





Contact Name
Rush Vasculitis Clinic
Contact Phone
(312) 563-2800
Contact E-mail
contact_rush@rush.edu



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Orthopedic Building
1611 W. Harrison St., Suite 510
Chicago, IL 60612



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