This disease, which is a type of vasculitis, was first reported by Buerger in 1908. He described it as one in which the characteristic pathologic findings are – acute inflammation and thrombosis (clotting), of arteries and veins affecting the hands and feet. Another name for Buerger’s Disease is thromboangiitis obliterans.
Who gets Buerger’s Disease?
The classic Buerger’s Disease patient is a young male (20-40 years old), who is a heavy cigarette smoker. More recently, however, a higher percentage of women and people over the age of 50 were found to have it. Most common in the Southeast Asia, India and the Middle East, it appears, however, to be rare among African Americans.
Symptoms include pain in the hands and/or feet, and the development of sores or lesions that do not heal. If Buerger’s disease is left untreated, gangrene can occur. Some other symptoms to look out for:
· Sensation of cold at extremities
· Sudden sweating
· Ulceration of extremities
· Gangrene of extremities
It isn’t clear what triggers Buerger’s disease. It’s possible that some people may have a genetic predisposition to the disease. Some research shows that it is caused by smoking and the use of chewing tobacco. It is theorised that tobacco triggers an autoimmune reaction, in which the body’s immune system mistakes healthy tissues as potentially dangerous invaders into the body, and attacks them. This causes inflammation and the development of clots in the arteries and veins of the hands and feet, that are characteristic of Buerger’s disease.
Tests and Diagnoses
While no tests can confirm whether you have the disease, your doctor can 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:
These are to look for certain substances, helping to rule out other conditions that may cause similar signs and symptoms. For instance, blood tests can identify scleroderma, lupus, blood-clotting disorders, 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. In the Allen’s test, you make a tight fist, which forces the blood out of your hand. Your doctor presses on the arteries at each side of your wrist to slow the flow of blood back into your hand, making your hand lose its normal colour. Next, you open your hand and your doctor releases the pressure on one artery, then the other. How quickly the colour returns to your hand may give a general indication about the health of your arteries. Slow blood flow into your hand may indicate a problem, such as Buerger’s disease.
An angiogram helps in reviewing the condition of your arteries. A special dye is injected into an artery, after which you undergo X-rays or other imaging tests. The dye helps to delineate any artery blockages that show up on the images. Your doctor may order angiograms of both your arms and legs even if you don’t have signs and symptoms of Buerger’s disease in all your limbs. The disease almost always affects more than one limb; so even though you may not have signs and symptoms in your other limbs, this test may detect early signs of vessel damage.
Making a diagnosis of this disease includes completing a thorough medical history, tobacco use history, and a physical examination. A misdiagnosis of Buerger’s disease is quite possible, due to the similarity in symptoms and complications to other diseases and conditions.
It can lead to serious complications if not treated promptly. Therefore, it’s essential that patients stop smoking immediately and completely. This is the only treatment known to be effective in Buerger’s disease. Patients who continue to smoke are generally the ones who require amputation of fingers and toes.
Despite the clear presence of inflammation in this disorder, anti-inflammatory agents such as steroids have not been shown to be beneficial. Similarly, strategies of thinning of the blood with aspirin or other agents to prevent clots have not generally proven effective. The only way to prevent the progression of the disease is abstinence from all tobacco products.
Other treatment approaches exist, but are less effective. Options include:
- 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 to control pain and increase blood flow, although this procedure is controversial
- Amputation, if infection or gangrene occurs.