Buerger’s Disease

Buerger's disease is a rare disease of the small and medium sized blood vessels of extremities that causes them to get inflamed, swollen, and blocked. Clots, called thrombi, may form in the lumen of the blood vessels. As a result, the blood flow to the hands and feet reduces to an extent to damage the skin tissues, and cause decay called gangrene.

Beginning in the hands and feet, the disease can spread up the arms and legs. Buerger’s disease is also called thromboangiitis obliterans (TAO). The single most important risk factor for Buerger’s disease is use of tobacco, either as cigarettes, chewing tobacco, or second hand or passive smoking.

Other risk factors are cold weather, stress, or diseases that narrow lumen of blood vessels like collagen diseases or atherosclerosis. Having somebody else affected with the disease is also a risk factor as genetic factors are supposed to be important.

Causes

The causes for Buerger’s disease are not precisely known. The swelling and inflammation are believed to be caused by vasculitis, where the defense system of the body, called the immune system, triggers the inflammation by default. There is also believed to be a genetic predisposition to this condition.

Cigarette smoking or use of tobacco products in any form precipitates the inflammation, swelling, and blockage.

The toxins in tobacco products are said to cause spam and narrowing of the blood vessels, hence causing the symptoms of Buerger’s disease.

  • The commonest initial symptom is pain. The pain aggravates on using hands and feet and seems to settle with rest. This phenomenon is called claudication.
  • The superficial blue blood vessels that carry blood from extremities to the heart may be inflamed, and hence appear prominent and painful to touch.
  • The fingers and toes may turn pale especially when exposed to cold. This is called the Raynaud’s phenomenon.
  • There may also be a tingling sensation. This happens because cold causes spasm of the blood vessels supplying blood to the extremities.
  • Painful sores and ulcers may appear on the skin as the skin tissues are deprived of blood.
  • Persistent paucity of blood supply to the skin causes decay, called gangrene. The tips of the fingers and toes may become black and the damage is irreversible.

The most feared complication of Buerger’s disease is gangrene. The skin overlying the affected part becomes blue or black, loses sensation, and may smell foul. Since this is permanent death of skin tissues, it can necessitate permanent surgical removal of the affected part, called amputation.

Ulcers that develop on the legs and arms may become infected. Muscles in nearby region go weak and may waste away over time.

Buerger’s disease is a high possibility in a smoker who complains of intermittent pain that comes with activity and settles with rest.

The doctor may feel the pulses in regions just above the affected parts. Pulse in the extremities may feel weak.

The doctor may then conduct the Allen’s test to check the speed of blood flow in the arms. The patient is required to make a fist and the doctor presses upon the blood vessel of the hand until the hand turns pale. This pressure is then slowly released to allow the blood to flow into the hand. How fast the blood flows and changes color is then noted.

Another test that may be done is arteriogram or angiogram. In this a dye is injected into the body such that it flows down to the blocked vessels. X-ray images are then taken to study the flow through the vessels. This is a reliable test that helps to detect even the early signs of disease. The blood flow characteristics can be studied by doing an ultrasound.

Blood tests may be done for ruling out other conditions like clotting disorders, or diabetes, and to study the activity of the immune system.

  • Giving up smoking and other tobacco products can halt the disease.
  • Medicines may be prescribed to dilate the blood vessels or dissolve the clots.
  • Some medicines may stimulate the growth of new blood vessels (therapeutic angiogenesis).
  • Surgery may be done to cut the nerves of the affected area to control pain and to increase blood flow.
  • The role of medicines and surgery though is not very well defined.
  • If there is persistent ulcer or gangrene, amputation may be necessary.
  • The best prevention is to quit tobacco in any form.
  • Medical help and community and family support should be sought to quit smoking.
  • Complications can be prevented by exercising precaution.
  • Extremes of cold should be avoided.
  • Footwear and gloves may provide warmth.
  • Shoes should be comfortable and well fitting.
  • Cotton socks should be preferred to those made in synthetic material.
  • Soft padding may be placed inside the shoes for protection.
  • Walking with bare feet should be avoided.
  • The extremities should be regularly inspected for any ulcers and sensation should be checked constantly.
  • If any ulcer or diminished sensations appear, medical help should be sought.
  • Moderate physical activity can be done after seeking medical advice.
  • A good nutritious diet should be taken.
  • Smoking is deleterious for your limbs. Quit now.