What is Buerger’s Disease? Symptoms and Treatment

by Abbas Jahangir · June 22, 2024

Vasculitides (inflammation of the vessels) are diseases that include many diseases and are characterized by the development of inflammation in the vessels. In Buerger’s disease, which is included in this group of disorders, inflammation occurs in the veins in the arms and legs. Edema and blockages that occur in these small vessels during the course of the disease may result in damage to the skin tissue. The development of Buerger’s disease is particularly associated with tobacco use.

What is Buerger’s Disease?

Buerger’s disease, also known as thromboangiitis obliterans or pruning disease among the public, is an inflammatory disease that affects small and medium-sized vessels especially in the lower and upper extremities. The group in which this disease is typically seen is male tobacco users between the ages of 20-50. Inflammation in the veins can cause blood flow in the hands and feet to slow down or stop over time.

Individuals with Buerger’s disease usually complain of weakness and pain (claudication) in the arm and leg muscles that relieve with rest. If the disease progresses, symptoms such as rest pain and wound development on the fingers may also be added to the disease picture.

There is currently no treatment method that can completely eliminate Buerger’s disease. Since almost all people suffering from this disease are tobacco users, the basis of the treatment approach is to stop tobacco use. By giving up this habit, a very positive improvement can be achieved in the course of the disease.

What are the causes of Buerger’s Disease?

Although the actual mechanism underlying Buerger’s disease has not yet been fully elucidated, tobacco use is a factor closely related to both the onset and progression of the disease.

There are various theories regarding the emergence of Buerger’s disease. According to some experts, chemicals exposed to tobacco use in people with Buerger’s disease may cause damage to various important structural substances such as collagen in the vascular wall. Another theory about the development of this disorder is that tobacco use creates an abnormal response to the vascular structures of the immune system in some people. Another issue that experts emphasize in the development of Buerger’s disease is genetic predisposition.

Risk factors considered to be effective in the development of Buerger’s disease can be summarized as follows:

Tobacco Use

The risk of developing Buerger’s disease is quite high in individuals who use tobacco. Use of tobacco in any form may be effective in the emergence of this disorder. Individuals who smoke rolled cigarettes or consume 1.5 packs of cigarettes per day constitute the group with the highest risk of developing Buerger’s disease. The Mediterranean basin, the Middle East and Asia are among the regions with the highest tobacco use.

Chronic Gum Diseases

Long-term infection in the gums is a factor that may be associated with the development of Buerger’s disease. However, the connection between these two diseases has not been clearly established yet.

Gender

Buerger’s disease is a disorder that is detected at much higher rates in men than in women. The underlying reason for this relationship may be that men use tobacco at a higher rate than women.

Age

Buerger disease is usually detected in individuals older than 45 years of age. Therefore, increasing age can be considered among the accepted risk factors for the development of this disease.

What are the symptoms of Buerger’s disease?

In Buerger disease, symptoms begin with the development of thrombus (clot) in the blood vessels. Restriction of normal blood flow and decreased oxygen and nutrient supply to the tissues may result in damage or death of these tissues. The first symptom of Buerger’s disease is usually pain in the affected area. Then, a complaint of weakness may be added to the pain symptom.

There are many signs and symptoms that may occur with the development of Buerger disease:

Temporary feeling of pain in hands and feet
Open wound on fingers
Inflammation in the veins
Fingers appear pale in cold environments

Worsening of the course of the disease may result in interruption of blood flow in the veins of the hands and feet. After the flow is interrupted, there is a significant decrease in blood flow, especially reaching the tips of the fingers. Tissues that do not receive sufficient nutritional and oxygen support may lose their vitality over time. This loss of vitality of the tissues may result in the development of gangrene, especially in the tips of the fingers and toes.

The development of dark blue or black skin, loss of sensation in the fingertips, or a strong odor in the affected areas are among the symptoms that may occur after the development of gangrene. Gangrene is a very important health problem that requires urgent intervention. To treat this problem, it is usually necessary to amputate the affected area.

How is Buerger’s Disease Diagnosed?

The diagnosis of Buerger disease is a clinical diagnosis. The concept of clinical diagnosis means that the diagnosis of this disorder is made based on the symptoms and findings of the person and that there is no specific test that can be used. However, this concept does not mean that no test can be used in Buerger’s disease. Many different tests can be used to distinguish between the symptoms that occur during the course of this disease and disorders that cause similar complaints.

Blood tests are tests that can be useful in distinguishing between Buerger’s disease and diabetes, lupus and other diseases that are prone to blood clots. Following these examinations, physicians may use various imaging methods to examine the vascular structures. The radiological examination called angiography is a special x-ray imaging method and is performed by physicians injecting contrast material into the person’s arteries. Excluding the presence of thrombus in vessels distant from the heart by echocardiography (ECHO) method is another diagnostic approach to Buerger’s disease.

Allen test is another test performed by physicians for the diagnosis of Buerger disease. The main purpose of this test is to evaluate blood flow in the hands. It should be noted that a positive test is not a condition that occurs only in Buerger’s disease. In this test, which is a simple way to measure blood flow, you must first make a fist with your hands tightly and ensure that the blood moves away from your hands to your arm.

On the other hand, doctors apply pressure to your arm veins, thus reducing the blood flow. During this process, it can be easily observed that the hand color gradually becomes lighter. Then the people open their hands. After this point, physicians stop applying pressure on the veins and examine how long it takes for the hand to return to its normal color when the vein is pressed. The fact that this period covers a long period of time can be considered as a finding indicating Buerger’s disease.

The course of Buerger’s disease may vary depending on whether people quit tobacco use or not. It should not be forgotten that amputation (cutting off a limb for medical purposes) may occur in approximately 43% of patients who do not give up this habit, on average within 8 years following diagnosis. For smokers who quit smoking, this rate is approximately 6%. Early diagnosis and treatment are very important in reducing the risk of amputation.

How is Buerger’s Disease Treated?

Although there is currently no definitive treatment for Buerger’s disease, the cornerstone of treatment is to stop tobacco use. Even smoking 1-2 cigarettes a day after the onset of the disease can cause the disease process to worsen.

Apart from ending this harmful habit, other practices that answer the question of how to cure Buerger’s disease are as follows:

Use of vasodilator drugs
Doing physical activity such as walking
Applying intermittent compression (pressure) to the arms and legs
Cutting the sensory nerves in the affected area (sympathectomy)

If you notice signs and symptoms in your body of Buerger’s disease, the course of which can be significantly improved by stopping tobacco use, it is recommended that you contact the nearest health institution and get support from specialist physicians.