Buerger’s disease

Buerger’s disease

Definition

Buerger’s disease or thrombangitis obliterans is an inflammatory occlusion of small and mediumsized peripheral arteries and veins of the upper and lower limbs.

Aetiology/pathophysiology

It occurs almost exclusively in heavy cigarette smokers and is therefore seen more in countries with high levels of smoking. There is segmental chronic inflammatory infiltration of the vessel walls with resultant obliteration of the lumen and secondary thrombosis.

Clinical features

The condition starts with digital ischaemia, ulceration preceded by claudication in the feet, or rest pain in the fingers or toes. The condition is progressive. Wrist and ankle pulses are usually absent but brachial and popliteal pulses are present. There may be a previous history of superficial thrombophlebitis.

Investigations

Arteriography shows narrowing or occlusion of small peripheral arteries with healthy main vessels.

Management

The condition remits with quitting smoking; nicotine replacement therapy cannot be used but bupropion (Zyban) is safe. Prostaglandin infusions, thrombolytic therapy, surgical sympathectomy and revascularistion procedures have been tried.