Buerger disease: Year of the Zebra
Buerger disease, also called thromboangiitis obliterans, is a condition characterized by inflammation of small- and medium-sized arteries and veins of the extremities.
The exact cause of Buerger disease is still unknown, however the single most important risk factor is long-term tobacco use.
The clot recruits more cells to the site, causing further blood vessel narrowing and inflammation, and a decrease in blood flow to tissues, called ischemia, which can lead to cell death.Individuals with Buerger disease typically present with intermittent claudication, which is intermittent pain that most often affects the calf, but can also involve the foot, thigh, or even the arms, and is induced by exercise and relieved by rest.
In cases of advanced disease, this pain may even come at rest, along with ulcers that result from the ischemia.Other signs and symptoms that may arise in the affected limb include paresthesia, or a ‘pins and needles’ sensation, as well as skin color and temperature changes.
Some individuals may also present with Raynaud phenomenon, meaning that when exposed to a trigger, such as emotional stress or exposure to cold temperatures, their fingers and toes turn white, then blue, and then red.In the most severe cases individuals could develop necrosis, or irreversible death of body tissue.Now, the diagnosis of Buerger disease is based on history and physical assessment.
Diagnostic tests may include an Allen test to assess the degree of arterial circulation to the individual’s hands. This can be followed by the ankle–brachial index, or ABI, test to rule out peripheral artery disease.
Finally, additional tests may focus on ruling out other conditions.Initial treatment is typically focused on the cessation of tobacco and avoiding triggers, like cold exposure.
If this is not enough, individuals may also require analgesics for the pain, as well as medications that help induce vasodilation and improve blood flow to the extremities, such as calcium channel blockers, phosphodiesterase-5 inhibitors, or topical nitrates.
Individuals with infected ulcers may also require antibiotics.In severe refractory cases, surgical treatment options might be considered.Alright, as a quick recap… Buerger disease is a condition where small- and medium-sized blood vessels become inflamed and narrowed.
As a result, there’s decreased blood flow, eventually leading to tissue ischemia and death. The single most important risk factor for developing Buerger disease is long-term tobacco use.
With Buerger disease individuals typically present with intermittent claudication, paresthesias, and skin color and temperature changes.Diagnosis is based on the history and physical assessment, and by ruling out other conditions.
Treatment is typically focused on cessation of tobacco, avoiding triggers, analgesics for pain, as well as vasodilator medications that help improve blood flow to the extremities.
Surgical treatments can also be considered in severe cases.
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