Buergers

Disease
dr Putra Hendra SpPD
UNIBA

Buergers Disease: What It Is

Buerger's disease (thromboangiitis obliterans) is
a rare disease characterized by a combination
of acute inflammation and thrombosis of the
arteries and veins in the hands and feet . The
obstruction of blood vessels in the hands and
feet reduces the availability of blood to the
tissues, causes pain and eventually damages or
destroys the tissue. It often leads skin
ulcerations and gangrene of fingers and toes.
Rarely, in advanced stages of the disease, it
may affect vessels in other parts of the body.

Buergers Disease: Appearance

Ulcers and Gangrene caused by Buergers
Disease

Buergers Disease: Who It Affects

Buerger's disease affects approximately six out
of every 10,000 people. It almost always affects
men, ages 20 to 40, who smoke or chew
tobacco. Recently, however, more women and
men over the age of 50 have been diagnosed
with Buerger's disease. This disorder is still very
uncommon in children, but it may occur in
those with autoimmune diseases. Buerger's
disease is most common in the Orient,
Southeast Asia, India and the Middle East, but
is rare among African-Americans.

etiology
unclear
1 external factors: tobacco, cold or
humid weather, chronic trauma,
infection
2 internal factors: immunologic
dysfunction
exposure to tobacco is essential for
both initiation and progression of the
disease.

Pathology
1. begin with artery, then vein, from distal
to proximal.
2. segmental disease
3. in active stage, nonsuppurtive
inflammation
4. in end stage, intraluminal thrombosis
progressively organizes, new capillary
formation, vascular fibrosis
5. ischemic change

Diagnosis
1. Age younger than 45 years, current (or
recent) history of tobacco use
2. Presence of distal-extremity ischemia
3. History of migratory superficial
thrombophlebitis
4. Impaired distal pulses.
5. Exclusion of autoimmune diseases,
hypercoagulable states, and diabetes mellitus
by laboratory tests

Buergers Disease: Symptoms

Enlarged, red, tender cord-like veins

Pain or tenderness
Numbness and tingling in the limbs
Skin ulcers or gangrene of the digits

Discoloration
Two or more limbs affected
Pain may increase with activity such as walking and
decrease with rest
Pulse may be decreased or absent in the affected extremity
Symptoms may worsen with exposure to cold or with
emotional stress

Clinical Features
Usually

presents as claudication, rest pain

Features

Atherosclerosis Buergers Ds

Age

> 40yo

20-45yo

Other risk factors

+++

no

Upper extremity
involvement

rare

Up to 90%

Proximal vessel
involvement

+++

rare

Pulse exam

decreased

preserved

Superficial
Thrombophlebitis

no

Up to 40%

Clinical findings
1.The hands and feet are usually cool.
2.skin is pale, or cyanosis.
3. Paresthesias.
4. pain in limbs, intermittent claudication
5. changes of nutritional dysfunction

Clinical stage
First stage: local ischemic stage
Second stage: nutritional ischemic stage
Third stage: necrotic stage

Special examination
1 Doppler examination
2 arteriography: formation of distinctive

small-vessel collaterals around areas of

occlusion known as "corkscrew
collaterals"

Normal and Abnormal Angiograms

Buergers Disease:
Angiogram
Angiogram of the Hand

Normal

In Buergers Disease

Buergers Disease: Treatment

The

only method known to be an effective

treatment for Buerger's disease is
immediately quitting smoking. Patients who
continue to smoke after a diagnosis of
Buerger's disease will generally require
amputation of the fingers and toes.

Since

there is no cure for Buerger's disease,

the goal of treatment is to control
symptoms.

Treatment
1 General treatment
Absolute discontinuation of tobacco use

is the only strategy proven to prevent

the progression of Buerger disease.
prevent trauma and thermal or chemical
injury, avoidance of cold environments,
drugs that lead to vasoconstriction
Buerger exercise

Treatment
1. vasodilators, antiplatelet drugs, and

anticoagulants
2. antibiotics to treat infected ulcers

 3. hypertension oxygen treatment

4. surgical treatment:to improve distal arterial

flow
(1) lumbar sympathectomy
(2) vascular reconstructive procedures :
bypass transfer, thrombosis
(3) Omental transfer
(4)Arteriovenous transfer
(5 )distal limb amputation for nonhealing
ulcers, gangrene

Buergers Disease: Prevention

To avoid the onset of Buerger's

disease, tobacco use should be
avoided, particularly by men.

Buergers Disease: Prognosis

The symptoms of Buerger's disease
may disappear if tobacco use is
stopped. If the affected extremity is
to be saved, the patient must stop
smoking. If infection or gangrene
occurs, amputation of the affect
extremity may be necessary.

Buergers Disease: Symptom

Control
Gentle

massage and warmth to increase

circulation
Avoid conditions that reduce circulation to the
extremities
Avoid sitting or standing in one position for
long periods
Do not walk barefoot to avoid injury
Do not wear tight or restrictive clothing
Report all injuries to physician for appropriate
treatment

Some People Just CANT Quit!

(Even if it costs an arm & a leg!)