Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content + Print Section ++ For further information, see CMDT Part 12-08: Thromboangiitis Obliterans (Buerger Disease) + Key Features Print Section ++ ++ Essentials of Diagnosis ++ Typically occurs in male cigarette smokers Distal extremities involved with severe ischemia progressing to tissue loss Thrombosis of the superficial veins may occur Amputation will be necessary unless patient stops smoking ++ General Considerations ++ Buerger disease is a segmental, inflammatory, and thrombotic process of the distal most arteries and occasionally veins of the extremities Cause is unknown but condition is rarely seen in nonsmokers Pathologic examination reveals arteritis in affected vessels Arteries most commonly affected are the plantar and digital vessels of the foot and lower leg In advanced stages, the fingers and hands may become involved Progression of disease seems to be intermittent with acute and dramatic episodes followed by some periods of remission ++ Demographics ++ Patients usually younger than 40 years old Incidence has decreased dramatically + Clinical Findings Print Section ++ ++ Symptoms and Signs ++ Lesions on the toes Superficial thrombophlebitis may aid the diagnosis Rest pain, particularly in the toes Pain often progresses to tissue loss and amputation, unless patient stops smoking Intermittent claudication is not common ++ Differential Diagnosis ++ Peripheral vascular disease Raynaud disease Repetitive atheroemboli + Diagnosis Print Section ++ ++ Imaging Studies ++ Magnetic resonance angiography or invasive angiography can demonstrate the obliteration of the distal arterial tree Biopsy of a tender cord from migratory thrombophlebitis is no longer necessary + Treatment Print Section ++ ++ Surgery ++ Sympathectomy is rarely effective ++ Therapeutic Procedures ++ Smoking cessation is mainstay of therapy and will halt disease in most cases Revascularization is not possible as the distal arterial tree is occluded + Outcome Print Section ++ ++ Complications ++ Amputation ++ Prognosis ++ Prognosis dependent on smoking cessation For patients who stop smoking, outlook may be better For those who do not stop smoking, prognosis is poor + References Print Section ++ + +Jorge VC et al. Buerger's disease (Thromboangiitis obliterans): a diagnostic challenge. BMJ Case Rep. 2011 Sep 13;2011. pii: bcr0820114621. [PubMed: 22679237] + +Klein-Weigel P et al. Buerger's disease: providing integrated care. J Multidiscip Healthc. 2016 Oct 12;9:511–8. [PubMed: 27785045]