Buerger’s disease (also known to doctors as thromboangiitis obliterans) is a rare disease that affects the veins and arteries in the legs and arms. It was named for Leo Buerger, who first described it in 1908.
When this disease is present, these blood vessels become inflamed and swollen, and blood clots may eventually appear, interfering with circulation and causing tissue damage in the extremities. Left untreated, Buerger’s disease can have serious consequences for your feet.
Symptoms and Signs of Buerger’s Disease To Look For
Symptoms that sufferers of Buerger’s disease may experience include:
- Pain in the legs and feet (particularly in the arch) that tends to accompany use of the feet—walking, running, etc.—and tends to ease when at rest
- Raynaud’s phenomenon—toes turn color and become numb and sensitive when exposed to even mildly cold air or water
- Painful open sores on the toes
Signs of Buerger’s disease that a doctor may recognize upon physical examination include vein inflammation just below the surface of the skin (this is caused by blood clots).
Why Did I Develop Buerger’s Disease?
The primary risk factor for Buerger’s disease is tobacco use, especially smoking. The disease tends mostly to strike men under the age of 40 (usually at around the age of 35), and only one patient in ten is a woman.
It is a rare condition in the United States—affecting just 12 people out of every 100,000—and becoming rarer as tobacco use declines, but it is more common in other parts of the world, particularly in the Middle East, where heavy smoking is more common.
While the greatest risk is to heavy smokers (those who smoke a pack and a half or more per day), Buerger’s disease can also result from the use of other tobacco products, including snuff or chewing tobacco.
Despite the fact that virtually all cases of Buerger’s disease occur in people who use tobacco, the connection between the disease and the habit is not entirely clear; it is possible that the condition may arise from irritation to the lining of the blood vessels caused by chemicals present in tobacco.
Another possibility is that the disease arises as part of an autoimmune response (an attack on the body’s tissues by its own immune system) that is somehow triggered by the tobacco.
This idea seems to be supported by the fact that while children are seldom the victims of this condition, it can sometimes occur in children suffering from systemic autoimmune diseases.
Buerger’s disease differs from circulatory disorders like peripheral vascular disease in that symptoms are not caused by narrowing of the artery due to the buildup of arterial plaque, but by the inflammation of arterial walls and the development of blood clots that block circulation.
Buerger’s disease has also been linked to chronic gum infection; the reason for this connection is not quite clear, but it may be related to the use of chewing tobacco or snuff.
Understanding the Progression and Complications of Buerger’s Disease
The initial symptom will be pain in the toes (and possibly the fingers) during exercise. This pain will radiate from the toes and into the feet and legs. At first, the sufferer will find that the pain disappears when he is at rest.
Eventually, however, the pain will be present even while resting, and the subject may experience occasional tingling in the toes. The toes may also turn white and become numb or painful upon exposure to cold (Raynaud’s phenomenon).
Eventually sores will begin to appear on the toes, and the subject will develop gangrene, necessitating the amputation of affected toes, or possibly even the entire foot.
How Is Buerger’s Disease Diagnosed?
Buerger’s disease can easily be mistaken for any of a number of diseases that cause impaired circulation in the extremities, including atherosclerosis, endocarditis (an infection in the heart), lupus, and scleroderma, to name just a few.
In pursuit of a diagnosis, a doctor who suspects Buerger’s disease may order an angiogram of the affected extremities.
An angiogram is an imaging technique whereby a radiation-opaque substance (i.e., something through which radiation cannot pass) is injected into the bloodstream and fluoroscopic images (like an x-ray, but a moving picture) are taken of the affected foot.
If the doctor’s suspicions are correct, the angiogram may show the blood clots, and it will also show that the blood vessels in the ankle have been twisted into a “corkscrew” shape characteristic of Buerger’s disease.
Treatment and Prevention of Buerger’s Disease
While the symptoms of Buerger’s disease can be treated to some extent (if only by resorting to the extreme step of amputating gangrenous toes and fingers), the only way to treat or prevent the disease itself is immediate smoking cessation.
The inflammation that accompanies this condition does not respond to steroidal anti-inflammatory drugs, nor does it respond to NSAIDs (non-steroidal anti-inflammatory drugs). Similarly, anticoagulation therapy—for example, thinning the blood with aspirin—is ineffective at preventing blood clots from forming.
Only tobacco use causes Buerger’s disease, and only quitting tobacco can stop it. Furthermore, while smoking cessation slows the progress of this disease, it does not halt it—so it is best to stop smoking before you begin to experience symptoms. There is no cure.
What is the Prognosis for Buerger’s Disease?
The prognosis for Buerger’s disease somewhat depends on how far the condition has advanced at the time it is diagnosed, and on the degree to which the patient is willing to cooperate when asked to give up smoking immediately.
Mild cases may show some improvement, but if the patient is unwilling to give up tobacco, his case is likely to end in amputation and death.