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Thromboangiitis Obliterans / Buerger's Disease

Definition :
Buerger's disease, also called thromboangiitis obliterans, is a rare disease of the arteries and veins in the arms and legs. Buerger's disease is characterized by a combination of inflammation and clots in the blood vessels, which impairs blood flow. This eventually damages or destroys tissues and may lead to infection and gangrene. Buerger's disease usually begins in the hands and feet and may progress to affect larger areas of the limbs.

Buerger's disease is rare in the United States, but is more common in the Middle East and Far East. Buerger's disease most commonly affects men between ages 20 and 40, though it's becoming more common in women.

Virtually everyone diagnosed with Buerger's disease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop Buerger's disease. For those who don't quit, amputation of all or part of a limb may ultimately be necessary.

Causes :
Buerger's disease is caused by inflammation in the arteries and veins of the arms and legs. Inflammatory cells — and eventually blood clots — form in the vessels and block blood flow in and out of your hands and feet. Reduced blood flow means that the tissue in your hands and feet doesn't get adequate oxygen and nutrients needed to sustain it. This leads to the signs and symptoms of Buerger's disease, beginning with pain and weakness in your fingers and toes and advancing to other parts of your arms and legs. It isn't clear what triggers the inflammation and clots.

Risk Factor :
Cigarette smoking greatly increases your risk of Buerger's disease. Heavy cigarette smokers are most likely to develop Buerger's disease, though it can occur in people who use any form of tobacco, including cigars and chewing tobacco. It isn't clear how tobacco use increases your risk of Buerger's disease, but virtually everyone diagnosed with Buerger's disease uses tobacco. Rates of Buerger's disease are highest in areas of the Middle East and Far East where heavy smoking is most common.

When to seek medical advice :
See your doctor if you think you may have signs or symptoms of Buerger's disease.

Symptoms :
Signs and symptoms of Buerger's disease include :
  • Pain and weakness in your legs and feet or your arms and hands
  • Swelling in your feet and hands
  • Fingers and toes that turn pale when exposed to cold (Raynaud's phenomenon)
  • Open sores on your fingers and toes

Dignosis :
Your doctor will ask you about your signs and symptoms. No tests can definitely determine whether you have Buerger's disease. Instead, doctors order tests to narrow the diagnosis and rule out other more common conditions. These tests may include :

Blood tests
Blood tests to look for certain substances can rule out other conditions that may cause similar signs and symptoms. For instance, blood tests can help rule out scleroderma, lupus, blood clotting disorders and diabetes, along with other diseases and conditions.

The Allen's test
Your doctor may conduct a simple test called the Allen's test to check blood flow through the arteries carrying blood to your hands. In the Allen's test, you make a tight fist, which forces the blood out of your hand. Your doctor alternately compresses the arteries at each side of your wrist to slow the flow of blood back into your hand. Next, you open your hand and your doctor releases the compression. How quickly the color returns to your hand may give a general indication about the health of your arteries. Slow blood flow into your hand may indicate a problem, such as Buerger's disease.

Arteriogram
An arteriogram, also called an angiogram, helps doctors see the condition of your arteries. Doctors inject dye into an artery and then take X-rays or other types of images. Images show any blockages in the artery. Your doctor may order arteriograms be performed on both of your arms and your legs — even if you don't have signs and symptoms of Buerger's disease in all of your limbs. Buerger's disease typically affects more than one limb, so even though you may not have signs and symptoms in your other limbs, this test may detect early signs of vessel damage.

Your doctor may order other tests and procedures to assist in diagnosing Buerger's disease.

Complication :
If Buerger's disease worsens, blood flow is slowed in your arms and legs. This is due to blockages that make it hard for blood to reach the tips of your fingers and toes. Tissues that don't receive blood don't get the oxygen and nutrients needed to survive. This can cause the skin and tissue on the ends of your fingers and toes to die (gangrene). Signs and symptoms of gangrene include black or blue skin, a loss of feeling in the affected finger or toe and a foul smell from the affected area. Gangrene is a serious condition that usually requires amputation of the affected finger or toe.

Treatment:
Quit using tobacco in any form
If you're diagnosed with Buerger's disease, you must stop using tobacco in order to stop progression of the disease. The inflammation stops when you quit using tobacco. Most people who quit tobacco won't have to face amputation of their fingers or toes in the future. Those who continue to use tobacco may worsen their Buerger's disease and need to have their affected fingers or toes removed.

It's hard to quit smoking. If you're like the majority of people who smoke, you've probably tried to quit in the past, but haven't been successful. Talk to your doctor about strategies to help you quit. Medications are available to ease your cravings. However, you won't be able to use nicotine replacement products, such as patches or gum, since the nicotine in these products also affects Buerger's disease.

Because it's imperative that you stop all tobacco use, your doctor may recommend more aggressive approaches to quitting. For instance, your doctor may periodically test your urine to make sure you aren't using tobacco. Another option is a residential smoking cessation program. In these programs, you stay at a treatment facility, sometimes a hospital, for a set number of days or weeks. During that time you participate in daily counseling sessions and other activities to help you deal with the cravings for cigarettes and to help you learn to live tobacco-free.

Other treatments
No treatments can cure Buerger's disease. Instead, your doctor may try various treatment approaches to reduce any signs and symptoms you have. Options include :

  • Medications to improve blood flow or to dissolve blood clots
  • Surgery to cut the nerves in the affected area (surgical sympathectomy) to control pain
  • Amputation, if infection or gangrene occurs

Prevention:
You can prevent Buerger's disease by quitting tobacco use. If you don't smoke, don't start.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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