Buerger’s Disease
Buerger’s Disease
is a nonatherosclerotic, segmental,
inflammatory, vasoocclusive disease that
affects the small and medium-sized arteries
and veins of the upper and lower extremities,
cyclic upset.
More common in males, aged 20-45 years.
Etiology
Unclear
• External factors: tobacco, cold or humid weather,
chronic trauma, infection
• Internal factors: immunologic dysfunction
• Exposure to tobacco is essential for both initiation and
progression of the disease.
Pathology
1. Begin with artery, then vein, from distal to proximal
2. Segmental disease
3. In active stage, nonsuppurtive inflammation
4. In end stage, intraluminal thrombosis progressively
organizes, new capillary formation, vascular fibrosis
5. Ischemic change
Clinical findings
• The hands and feet are usually cool.
• Skin is pale, or cyanosis.
• Paresthesias.
• Pain in limbs, intermittent claudication
• Changes of nutritional dysfunction
• Impaired distal pulses in the presence of
normal proximal pulses.
• Migratory superficial thrombophlebitis.
• Painful ulcerations and/or frank gangrene
of the digits.
Buerger’s Disease: Appearance
Symptoms
• Enlarged, red, tender cord-like veins
• Pain or tenderness
• Numbness and tingling in the limbs
• Skin ulcers or gangrene of the digits
• Discoloration
• Two or more limbs affected
• Pain may increase with activity such as walking and decrease with rest
• Pulse may be decreased or absent in the affected extremity
• Symptoms may worsen with exposure to cold or with emotional stress
Diagnosis
• Buerger's disease is often masked by a wide variety of other
diseases that cause diminished blood flow to the hands and feet,
therefore, other disorders must be ruled out with aggressive
evaluation.
• An angiogram or an arteriogram of the upper and lower
extremities
• A Doppler ultrasound
• Skin biopsies are rarely used because of concern that the biopsy
site near an area with poor blood circulation will not heal.
Normal and Abnormal Angiograms
Buerger’s Disease: Angiogram
Angiogram of the Hand
Normal Buerger’s Disease
Prevention
To avoid the onset of Buerger's disease,
tobacco use should be avoided, particularly
by men.
Treatment
• The only method known to be an effective treatment for Buerger's
disease is immediately QUITTING SMOKING. Patients who continue
to smoke after a diagnosis of Buerger's disease will generally
require amputation of the fingers and toes.
• Since there is no cure for Buerger's disease, the goal of treatment is
to control symptoms.
Symptoms Control
• Gentle massage and warmth to increase circulation
• Avoid conditions that reduce circulation to the
extremities
• Avoid sitting or standing in one position for long
periods
• Do not walk barefoot to avoid injury
• Do not wear tight or restrictive clothing
• Report all injuries to physician for appropriate
treatment
Prognosis
The symptoms of Buerger's disease may
disappear if tobacco use is stopped.
If the affected extremity is to be saved, the
patient must stop smoking.
If infection or gangrene occurs, amputation of
the affect extremity may be necessary.
Differential diagnosis
• Atherosclerosis obliterans
• Takayasu’s arteritis
• Diabetes mellitus
Raynaud’s
Phenomenon
Helen Kline
Scottish Radiology Society
What Is Raynaud’s Phenomenon???
• The discoloration of fingers and/or toes
• More serious form of disease
Primary Raynauds
• Most common form of Raynauds skin disorder
• No underlying disease or associated medical
problem
Who’s at Risk???
• Usually begins between 15 years old and 40
years old
• More common in women than men
Causes
• Unknown
Guesses Include:
• Nerve control of the blood vessel diameter is abnormal
• Nerve sensitivity to cold temperatures
Symptoms
• Swelling, tingling, aching, throbbing
• Change in skin color (blue, purple, white)
• Numbness
• Pain
• Sores
Episodes last about 15 minutes
Conditions Associated with
Raynaud’s Phenomenon
• Rheumatic diseases
• Trauma (frostbite)
• Hormonal Imblance
• Inderal (blocks a portion of the sympathetic
system)
• Blenoxane (used in cancer treatments
• Nicotine
Non-Drug
Treatment/Prevention
• Stay warm
• Quit Smoking
• Reduce Stress and alcohol consumption
• Exercise
• Avoids tools that vibrate
• See a doctor regularly
Drug Treatment
• calcium-channel blockers: dilate blood vessels
• alpha-blockers: the norepinephrine hormone
(increases blood pressure)
• nitroglycerine paste: heals ulcers
