What is Buerger's Disease ?
Introduction
Buerger's Disease is also known as Thromboangiitis Obliterans which is a type of Inflammatory Disease of Arterial and Venous system. Buerger's Disease was first described by Winiwarter and details were published by Leo Buerger.
Definition of Buerger's Disease
Buerger's Disease is the inflammatory reaction in the arterial wall with the involvement of neighbouring vein and nerve, terminating in thrombosis of the artery
Etiology of Buerger's Disease
- Cigarette Smoking: Nicotine produces severe vasospasm and excessive smoking increases the level of carboxyhemoglobin which damage the blood vessels
- Lower socioeconomic groups: Recurrent trauma to foot, poor hygiene
- Hypercoagulable state
- Autonomic hyperactivity
- Autoimmune factors
- Familial predisposition: Genetic factor
- Associated with Rickettsial disease
Pathology of Buerger's Disease
- Panarteritis: Diffuse inflammatory reaction involving all 3 coats of blood vessels, causing a thrombus which leads to occlusion of lumen (Obliterans)
- Arteries surrounded by a dense fibrotic reaction which involves neighbouring veins and sometimes nerves
- Affected superficial vein produces characteristic migratory, recurrent superficial phlebitis
- Acute Lesion shows acute Arteritis / Periarteritis / Phlebitis / Periphlebitis
- Chronic Lesion shows arteries and veins bound to each other by Fibrous adhesions
Clinical Features of Buerger's Disease
- Thromboangiitis Obliterans predominantly affects male smokers between age group of 20 - 40 years
- Foot Claudication: Pain in foot arch while walking due to peripheral involvement of pedal arteries
- Intermittent Claudication: Pain is increased when muscle is exercised and disappears when the exercise stops
- In chronic ischaemia intermittent claudication progresses to Rest Pain
- Gradual postural colour changes
- Ulceration and Gangrene of digits and finally the entire foot or hand requires amputation
- Phlebitis and ischemic neuritis may also lead to pain
- Limbs become rubor or red on dependence and pallor on elevation
- Vessels involved are Dorsalis pedis, Posterior tibial and Popliteal
Physical Examination of Buerger's Disease
Inspection:
- Signs of chronic tissue ischemia are seen before gangrene develops eg. loss of hairs from digits, atrophy of skin, brittle nails
- Sharply demarcated ischemic area with good circulation to adjacent tissues followed by ulceration and gangrene
- Gradually gangrene involves whole foot and hand
Palpation:
- Absence of poserior tibial / dorsalis pedis / radial nerve pulse
Investigations of Buerger's Disease
- Patient history
- Clinical feature
- Arteriography / Angiography: Cock screw / Tree root / Spider leg pattern of vessels, showing the occlusion of small peripheral arteries
Treatment of Buerger's Disease
A) Conservative Treatment
- Stoppage of Cigarette Smoking
- Medicines: Vasodilator, Anticoagulants, Dextran, Phenylbutazone and Steroids
- Prostaglandin therapy prevents platelet aggregation
B) Surgical Treatment
- Sympathectomy
- Arterial reconstruction
- Microvascular transplantation of free omental grafts
- Amputation in case of severe gangrene
