Buerger's disease (patient information)

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 * Associate Editors-In-Chief: Jinhui Wu, MD Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Buerger's disease, also called thromboangiitis obliterans, is a rare disease in which blood vessels of the hands and feet become obstructed. Clinical data demonstrate that smoking is the common risk factor of Buerger's disease. Usual signs and symptoms include pain and weakness, or swelling in the legs and feet or arms and hands. Tests, such as a Doppler ultrasound of the extremity and angiogram, may tell the damage of the vessles. Blood tests are used to rule out other diseases such as scleroderma or systemic lupus erythematosus. Treatments of Buerger's disease include medications to improve the circulation and surgrery. Keep a good life-style is very important for prevention, treatment and prognosis of Buerger's disease.

What are the symptoms of Buerger's disease?
Patients with Buerger's disease may experience symptoms as the following:
 * Pain and weakness in the legs and feet or arms and hands
 * Swelling in your feet and hands
 * Fingers and toes that turn pale when exposed to cold (Raynaud's phenomenon)
 * Skin ulcers

Diseases with similar symptoms
 * Atherosclerosis
 * Raynaud phenomenon
 * Frostbite
 * Scleroderma
 * Systemic lupus erythematosus

What causes Buerger's disease?
Thromboangiitis obliterans (Buerger's disease) is caused by vasculitis (inflammation of the blood vessels).

The blood vessels of the hands and feet are especially affected. They tighten or become totally blocked. The average age when symptoms begin is around 35 years. Woman and older adults are affected less often.

Thromboangiitis obliterans mostly affects men ages 20 to 40 who have a history of heavy smoking or chewing tobacco. Only 1 out of 10 patients are women.

The condition may also be related to a history of Raynaud's disease.

This disorder is very uncommon in children, but it may occur in children with autoimmune diseases.

Who is at highest risk?

 * Smoking
 * Patients with medical history of Raynaud's disease or autoimmune diseases
 * Race: Buerger disease is relatively more common in people of natives of India, Korea, and Japan, and Israeli Jews of Ashkenazi descent.
 * Gender: Buerger disease is as 3 times as common in males than in female.
 * Age between 20~45 years

When to seek urgent medical care?
Call your health care provider if symptoms of Buerger's disease develop.

Diagnosis
Physicians will run the following test to confirm the disease
 * Blood tests: Blood tests, including complete blood count, glucose, liver function test, serum creatinine determination, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, rheumatoid factor, anticentromere antibody, antiphospholipid antibodies may help rule out diseases such as diabetes, scleroderma, systemic lupus erythematosus and other disorders.
 * The Allen's test: The goal of this test is to check the function of your vessles. During the procedure, the patient is asked to make a tight fist. And, the doctor presses on the arteries at each side of the wrist. These two steps can decrease the flow of blood into the hands and make your hands lose color. Then, you are asked to open your hands and the doctor releases the pressure on one artery and another. The doctor will record the time for your hands to return to general appearance. Patients with Buerger's disease may slow blood flow into the hands.
 * A Doppler ultrasound of the extremity: This test uses ultrasound to examine the blood flow in your arteries and veins. Patients with Buerger's disease may show signs of narrowing or closure, and the arteries have normal blood pressure.
 * Angiogram: This test can detect early signs of vessel damage and help the doctor know the condition of your arteries. During the procedure, the dye is injected into an artery and then take X-rays image. On images, patients with Buerger's disease may show signs of blockages in the artery.

Treatment options
The goal of treatment for Buerger's diseasa is to control symptoms.
 * Quitting smoking
 * Keep warm and do regular exercises may help increase circulation.
 * Medications: The following medications have shown somewhat effective in improving distal blood flow and relieve symptoms.
 * Iloprost, a prostaglandin analogue
 * Stem cell injection
 * Streptokinase


 * Surgery: Cutting the nerves in the affected area may help control pain.
 * Amputation: This treatment is used when infection or gangrene occurs.

Where to find medical care for Buerger's disease?
Directions to Hospitals Treating Buerger's disease

What to expect (Outlook/Prognosis)?
Prognosis of Buerger's disease varies from person to person, depending on:
 * The patient's life-style
 * The severity of the damaged vessles.

Possible complications

 * Give up smoking
 * Keep warm

The disease might can complications like
 * Amputation
 * Gangrene (tissue death)
 * Loss of circulation beyond the affected hand or foot