Thromboangiitis Obliterans, which is also named as Buerger's Disease was first documented and reported by Buerger in the year 1908. Thromboangiitis Obliterans or Buerger’s Disease is caused due to internal inflammation of the arteries and veins, mainly of the hands and feet. Moreover, the blood vessels also become blocked with blood clots (thrombosis) in the disease called Thromboangiitis Obliterans or Buerger’s Disease. It is very painful and mostly occurs in the limb terminals, finger tips and toes, and then at severe condition this inflammatory endarteritis (inflammation in the inner lining of arteries) spreads towards hands and legs.

Thromboangiitis Obliterans or Buerger’s Disease causes damage of tissues especially the skin tissues of the affected area. Thromboangiitis Obliterans or Buerger’s Disease happens because of inadequate rich of cellular oxygen and nutrients through blood, as blood can’t reach to the affected area due to low blood circulation having the clogged arteries.

Thromboangiitis Obliterans or Buerger's Disease

Symptoms of Thromboangiitis Obliterans or Buerger's disease

Thromboangiitis Obliterans or Buerger’s Disease comes with the symptoms of pain and tissue damage (necrosis).

  • One of the common symptoms of Thromboangiitis Obliterans or Buerger’s Disease is pain that comes and goes either in your hands and arms or in your legs and feet. The pain also may come in both your hands and legs during exercise or when you rest after your exercise or physical activities.
  • The inflamed veins just beneath the skin surface due to blood clot are the reason of tissue damage or skin tissue damage, and it is another symptom of Thromboangiitis Obliterans or Buerger’s Disease. Abnormal cellular death with necrosis leads to spread it from finger tips to hands and arms at the later stage.
  • In exposure to cold temperatures, fingers and toes of a patient having Thromboangiitis Obliterans or Buerger’s Disease turn pale.
  • There are symptoms of open sores on fingers and toes of the person suffering from Thromboangiitis Obliterans or Buerger’s Disease.

Epidemiology of Thromboangiitis Obliterans or Buerger's Disease

According to reports, Thromboangiitis Obliterans or Buerger’s Disease is very common to men than women. It is because more men smoke than women. It is not only about smoking, but there is a direct relation between Thromboangiitis Obliterans or Buerger’s Disease and tobacco. People with record of chewing tobacco are also found and highly susceptible to Thromboangiitis Obliterans or Buerger’s Disease. Mostly people of Middle East and Asia along with Mediterranean are found to be more affected with Thromboangiitis Obliterans or Buerger’s Disease as per their higher rate of smoking activities.

In the United States 0.75% of all patients with the symptoms of peripheral vascular disease are found with Thromboangiitis Obliterans or Buerger’s Disease.

Causes of Thromboangiitis Obliterans or Buerger's Disease

Thromboangiitis Obliterans or Buerger’s Disease is mainly caused due to inner line inflammation of arteries and veins (blood vessels) and the blood clot formation in those blood vessels. These inflamed clogged blood vessels with blood clot cannot let the blood flow and reach the tissues of the affected areas. This is the reason why the tissues of the affected finger tips and toes become damaged due to inadequate amount of cellular oxygen and nutrients from the blood.

It is found that chain smokers are mostly diagnosed with Thromboangiitis Obliterans or Buerger’s Disease. People with moderate smoking are also found with thromboangiitis obliterans. So, there is a relation between tobacco and thromboangiitis obliterans, because not only smokers, but also people with habit of chewing tobacco become victim of Thromboangiitis Obliterans or Buerger’s Disease.

Although, scientists are still trying to find out the pathophysiology of how tobacco affects and triggers Thromboangiitis Obliterans or Buerger’s Disease; yet, there is a hypothesis which states that some constituent of tobacco may trigger body’s auto immune reaction where body’s own immune system attacks its own tissues and cells.

A severe condition of Thromboangiitis Obliterans or Buerger’s Disease may develop gangrene. This is a very painful condition and the only relief from this pain and the spread of tissue damage to other organs is amputation of the affected part or area.

Diagnosis of Thromboangiitis Obliterans or Buerger's Disease

There are no such diagnostic tests or blood tests to diagnose Thromboangiitis Obliterans or Buerger’s Disease. However, a lot of conclusions can be generated if the diagnosis of atherosclerosis is mixed up with Thromboangiitis Obliterans or Buerger’s Disease.

In atherosclerosis, cholesterol plaques are formed in the blood vessels and arteries. Other similar diseases like endocarditis where infection is found in the lining of heart and types of vasculitis can help in diagnosing the condition when these are ruled out. Some tests that rule out other disease and in turn confirms Thromboangiitis Obliterans or Buerger’s Disease are:

  • Blood Tests to Rule Out Other Conditions for Diagnosing Thromboangiitis Obliterans or Buerger’s Disease: Blood tests that help in diagnosing diseases like Scleroderma, Diabetes, Lupus, and other blood clotting disorders are done to check for their presence. A diagnosis for Thromboangiitis Obliterans or Buerger’s Disease can be made when these conditions are ruled out.
  • Angiogram: The test called angiogram with upper and the lower extremities helps a lot to diagnose thromboangiitis obliterans or the Buerger's disease. In this case the doctor or clinician injects a dye into the arteries to find out the blockage in the blood vessels performing X-ray of that region. This dye helps to view the blockages of clogged vessels after performing X-ray.
  • Allen’s Test: There is another test, named Allen test. In this test doctor presses on the artery of the patient’s hand after he make a tight fist. Doctor releases that pressure one by one when the patient opens his fist. The colour of the hand should turn from pale to the original colour after the release of fist, but if the change of colour becomes slow that might be a sign of thromboangiitis obliterans.

Risk Factors of Thromboangiitis Obliterans or Buerger's Disease

There are certain amounts of risk factors associated with thromboangiitis obliterans or the Buerger's disease. Here are few of them:

  • Use of Tobacco: Cigarette smoking increases the risk of having Thromboangiitis Obliterans or Buerger’s Disease. It is recorded that people who are involved into smoking are mostly diagnosed and found with Buerger's disease. People even with the habit of chewing tobacco are also in the list of being affected with Thromboangiitis Obliterans or Buerger’s Disease. Smokers using hand rolled cigarettes having raw tobacco in it are mostly susceptible for the Buerger's disease.

However, it is still under study why people having tobacco for long time are mainly found with Thromboangiitis Obliterans or Buerger’s Disease. There is an assumption that some chemicals in tobacco may disrupt the lining of veins and arteries to make them swell. People with Thromboangiitis Obliterans or Buerger’s Disease are mostly found in the region of Middle East and Asia along with Mediterranean.

  • Gender: Males are more susceptible than females, but females having the habit of smoking and chewing tobacco are also found with Thromboangiitis Obliterans or Buerger’s Disease. The difference may be because of a reason that smoking rate in males is higher than females.
  • Chronic Gum Disease: A prolonged disease or infection in gum may also trigger thromboangiitis obliterans or the Buerger's disease.

Treatment of Thromboangiitis Obliterans or Buerger's Disease

There is no such kind of medication to get relief from Thromboangiitis Obliterans or Buerger’s Disease. The one and only thing is quitting smoking which can make the patient cure of it. The patients continuing smoking may need to go for amputation to eliminate the affected areas. This amputation is needed at the severe cases when the process of tissue damage of affected terminal areas lead to gangrene and may spread to other parts of the body due to necrosis.

Sometimes surgical procedure is needed to cut the affected nerves. This helps to reduce and eliminate the pain. Some anti-coagulating agents are used to prevent the blood clots in the terminal blood vessels (arteries and veins). However, these agents are not always proven effective to cure thromboangiitis obliterans or Buerger's disease.

Lifestyle and Coping with Thromboangiitis Obliterans or Buerger's Disease

A tobacco free life often helps in preventing and treating Thromboangiitis Obliterans or Buerger’s Disease. Even if the disease has already set in, a person having the habit of smoking or chewing tobacco must quit this habit to prevent the worsening of the condition and to not undergo the process of amputation (cut out limbs) at the later age.

A healthy life with good diet and regular exercise having zero consumption of tobacco assures that there is no risk of thromboangiitis obliterans or Buerger's disease.

Conclusion

There is no need to say that people can lead healthy painless life with no extra addiction for tobacco. Sometimes people with addiction of tobacco may have to take extra burden of the painful deadly Thromboangiitis Obliterans or Buerger’s Disease. Although other risk factors are also there, yet removing this one major reason can make a lot of difference. Moreover, it is always better to live a healthy life with healthy diet and regular exercise. The habit of regular exercise additionally helps in blood circulation and reduces the chances of plaque formation.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: July 18, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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