Thromboangiitis Obliterans (Buerger Disease)

Key Features

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 patients who do not smoke cigarettes

• 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

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

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

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

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