Buerger's disease (thromboangitis obliterans)

Buerger's disease, also called thromboangitis obliterans, is a rare form of vasculitis characterized by acute inflammation and clotting of the arteries and veins of the hands and feet. The inflammation can lead to blockages of the arteries of the lower portions of the arms and legs. These blockages can cause critical limb ischemia and/or claudication, rest pain and non-healing sores or ulcers, in the hands and/or feet.

Buerger's disease, which occurs almost exclusively in heavy smokers, is different from peripheral arterial disease (PAD) in that it is not caused by atherosclerosis (plaque buildup in the arteries). The disease can cause pain in the hands and feet in response to exercise due to reduced blood-flow.

The most common symptoms of Buerger's disease are rest pain, skin ulcerations and gangrene of the fingers and toes. Sometimes people with the disease also experience coldness, numbness or tingling of the feet and hands.

Buerger's disease occurs almost exclusively in heavy tobacco users, including those who smoke cigarettes or chew tobacco. It occurs most often in those between the ages of 20 and 40 years old and is more common in men and those with a history of high cholesterol, high blood pressure or diabetes.

The symptoms of Buerger's disease can resemble those of other diseases and a thorough evaluation by a physician is needed to determine their true cause. In general, physicians use four criteria in making the diagnosis:

• Rest pain or ulceration in the hands or feet before age 50
• Tobacco use
• Tests indicating blockage of arteries
• No other causes of artery blockage or clot development

The most common test for artery blockage is the angiogram, an X-ray taken after the injection of dye.

There is only one treatment for Buerger's disease — immediate and complete cessation of smoking and other tobacco use. People with the disease who continue to smoke risk amputation.