Buerger’s Disease

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Buerger’s disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms and legs. In Buerger’s disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi). This eventually damages or destroys skin tissues and may lead to infection and gangrene. Buerger’s disease usually first shows in the hands and feet and may eventually affect larger areas of your arms and legs.

Symptoms

Buerger’s disease symptoms include:

  • Pain that may come and go in your legs and feet or in your arms and hands. This pain typically occurs when you use your hands or feet and eases when you stop that activity (claudication).
  • Inflammation along a vein just below the skin’s surface (due to a blood clot in the vein).
  • Fingers and toes that turn pale when exposed to cold (Raynaud’s phenomenon).
  • Painful open sores on your fingers and toes.

When to see a doctor

See your doctor if you think you may have signs or symptoms of Buerger’s disease.

Causes

It isn’t clear what triggers Buerger’s disease. It’s possible that some people may have a genetic predisposition to the disease. The condition is characterized by swelling in the arteries and veins of the arms and legs. The cells that cause the inflammation and swelling — and eventually blood clots — form in the vessels leading to your hands and feet and block the blood flow to those parts of your body.

Reduced blood flow means that the skin tissue in your hands and feet doesn’t get adequate oxygen and nutrients. This leads to the signs and symptoms of Buerger’s disease, beginning with pain and weakness in your fingers and toes and spreading to other parts of your arms and legs.

Risk factors

Tobacco use

Cigarette smoking greatly increases your risk of Buerger’s disease. Heavy cigarette smokers (people who smoke one and a half packs a day or more) are most likely to develop Buerger’s disease.

Chronic gum disease

Long-term infection of the gums also is linked to the development of Buerger’s disease.

Complications

If Buerger’s disease worsens, blood flow to your arms and legs decreases. 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 they need 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.

Tests and diagnosis

While no tests can confirm whether you have Buerger’s disease, your doctor will likely order tests to rule out other more common conditions or confirm suspicion of Buerger’s disease brought on by your signs and symptoms. 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 perform a simple test called the Allen’s test to check blood flow through the arteries carrying blood to your hands. .

Angiogram

An angiogram, also called an arteriogram, helps to see the condition of your arteries.

Treatments and drugs

Smoking cessation

Although no treatment can cure Buerger’s disease, the most effective way to halt the disease’s progress is to quit using all tobacco products. Even a few cigarettes a day can worsen the disease.

Your doctor can counsel you and recommend medications to help you stop smoking and stop the swelling in your blood vessels.

Other treatments

Other treatment approaches exist but are less effective. Options include:

  • Medications to dilate blood vessels, improve blood flow or dissolve blood clots
  • Intermittent compression of the arms and legs to increase blood flow to your extremities
  • Spinal cord stimulation
  • Surgery to cut the nerves to the affected area (surgical sympathectomy) to control pain and increase blood flow, although this procedure is controversial
  • Medications to stimulate growth of new blood vessels (therapeutic angiogenesis), an approach that is considered experimental by many
  • Amputation, if infection or gangrene occurs

Lifestyle and home remedies

Take care of your fingers and toes if you have Buerger’s disease. Check the skin on your arms and legs daily for cuts and scrapes, keeping in mind that if you’ve lost feeling to a finger or toe you may not feel, for example, a cut when it happens. Keep your fingers and toes protected and avoid exposing them to cold.

Prevention

Quit using tobacco in any form

 

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