Published: 18 Jun 2025

ICD9: 443.1      ICD10: I73.1      ICD11: 4A44.8

Buerger's disease, also known as thromboangiitis obliterans, is a rare disease affecting the small and medium-sized arteries and veins in the arms and legs.
These blood vessels become inflamed, swell, and can become blocked with blood clots (thrombi). This restricts blood flow, ultimately leading to pain, tissue damage, and even gangrene (tissue death).

Here's a breakdown of the key aspects of Buerger's disease:

Key Characteristics:

Inflammation: The primary process is inflammation of the blood vessel walls.
Thrombosis: The inflammation leads to the formation of blood clots (thrombi) that obstruct the arteries and veins.
Location: Primarily affects the small and medium-sized blood vessels of the extremities (arms and legs).
Strong Association with Tobacco Use: Buerger's disease is strongly linked to tobacco use, particularly smoking cigarettes. It is relatively rare in people who don't use tobacco.
Progression: The disease typically starts in the distal extremities (fingers and toes) and can progress proximally (towards the body).

Symptoms:

Pain: Often the first and most prominent symptom. It can occur in the hands, feet, legs, or arms, even at rest. Pain worsens with activity (claudication).
Claudication: Pain in the legs or feet during exercise that is relieved by rest. This is due to reduced blood flow to the muscles.
Color Changes: The affected fingers and toes can become pale (white), red, or bluish in color, especially when exposed to cold (Raynaud's phenomenon is common).
Numbness and Tingling: A feeling of pins and needles in the affected extremities.
Ulcers and Sores: Open sores on the fingers and toes that are slow to heal.
Gangrene: Tissue death due to lack of blood supply. This is a serious complication that can lead to amputation.
Superficial Thrombophlebitis: Inflammation of a vein just below the surface of the skin.

Causes:

Tobacco Use: The exact mechanism isn't fully understood, but tobacco use is the most significant risk factor. The chemicals in tobacco are thought to trigger inflammation and damage to the blood vessels. All forms of tobacco (cigarettes, chewing tobacco, e-cigarettes) are implicated.
Possible Genetic Predisposition: Some evidence suggests a genetic component, meaning that certain individuals may be more susceptible to the disease if they use tobacco.
Immune System Involvement: There may be an autoimmune component, where the body's immune system mistakenly attacks the blood vessels.

Diagnosis:

Medical History and Physical Exam: The doctor will ask about your symptoms, tobacco use, and medical history. They will also perform a physical examination to assess your circulation.
Arteriography (Angiography): This is an imaging test that uses dye and X-rays to visualize the arteries and identify any blockages or narrowing.
Blood Tests: To rule out other conditions that can cause similar symptoms, such as atherosclerosis or autoimmune diseases.
Allen Test: Evaluates blood flow to the hand by compressing the radial and ulnar arteries.
Biopsy: In rare cases, a biopsy of an affected blood vessel may be performed to confirm the diagnosis.

Treatment:

Smoking Cessation: This is the most important step in managing Buerger's disease. Quitting tobacco can significantly slow the progression of the disease and prevent further complications. Even reducing tobacco use is generally not enough.
Pain Management: Pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids, may be prescribed.
Wound Care: Ulcers and sores require meticulous wound care to prevent infection.
Vasodilators: Medications that help to widen blood vessels and improve blood flow.
Sympathectomy: A surgical procedure to cut the sympathetic nerves that control blood vessel constriction. This can help to improve blood flow to the affected areas. Its effectiveness is variable.
Amputation: In severe cases, amputation of the affected fingers, toes, or limbs may be necessary to prevent the spread of infection and relieve pain.
Other Therapies: Research is ongoing into other potential treatments, such as hyperbaric oxygen therapy and stem cell therapy.

Prognosis:

The prognosis for Buerger's disease depends largely on whether the individual is able to quit tobacco use. If smoking is continued, the disease will almost certainly progress, leading to further complications and potentially amputation. With smoking cessation, the disease can often be stabilized, and the individual can maintain a reasonable quality of life.

Important Considerations:

Early Diagnosis is Crucial: The earlier Buerger's disease is diagnosed, the better the chances of preventing serious complications.
Tobacco Use is the Key: Emphasize the absolute necessity of stopping all tobacco use. This is often the most challenging aspect of treatment.
Multidisciplinary Approach: Management of Buerger's disease often requires a team approach involving a vascular surgeon, pain management specialist, wound care specialist, and other healthcare professionals.
Education and Support: Patients need to be educated about the disease, its risks, and the importance of adherence to treatment. Support groups can be helpful in providing emotional support and practical advice.

In summary, Buerger's disease is a serious condition that can lead to significant disability. The most important step in management is complete smoking cessation. If you suspect you have Buerger's disease, consult with a doctor for diagnosis and treatment.