Buerger’s Disease (Thromboangiitis Obliterans)

Pathophysiology of Buerger’s Disease

Buerger’s disease is

1) occlusive disease of medium- and small-size arteries and veins, most commonly affecting the distal arms and legs (also occasionally in visceral, coronary, and cerebral arteries)
2) cause – unknown but there is a strong relationship to cigarette smoking

Signs and Symptoms

1) classic triad – distal claudication in involved extremity (hand, forearm, calf, and feet), Raynaud’s phenomenon, and migratory superficial vein thrombophlebitis
2) trophic changes in nails
3) distal gangrene
4) distal painful ulcerations
5) absent distal pulses (brachial and popliteal pulses are usually normal)

Characteristic Test Findings

Arteriography – occlusions are smooth and tapering (not areas of focal stenosis) with presence of collaterals

Histology/Gross Pathology

1) initial stage – neutrophil infiltration of vessel walls with thrombus in the vascular lumen
2) later stage – fibroblasts and giant cells replace neutrophils with fibrosis and recanalization of lumen

Associated Conditions

cigarette smoking

Inheritance/Epidemiology

1) most frequent in men under 40
2) more common in Asian and eastern European men

Treatment

1) cessation of smoking
2) arterial bypass of larger vessels involved
3) antibiotics if tissue infection is present

Tips for USMLE

1) if patient is a 32 year old Japanese man who smokes two packs/day and has pain in his right fingers with ulcerations on three fingertips on the right hand, think thromboangiitis obliterans
2) Buerger’s disease is thromboangiitis obliterans; Berger’s disease is IgA nephropathy