Buerger’s Disease: Understanding Causes, Symptoms, and Treatment Options

Buerger’s disease, or thromboangiitis obliterans, is a rare serious medical condition affecting the blood vessels, primarily in the arms and legs. This condition is characterised by inflammation leading to the blockage of small and medium-sized arteries and veins, reducing blood flow to the affected areas.  

Buerger’s disease can occur in both men and women of different ages. It is most common in those between 20 and 40 years. The disease is also reported in 45% to 63% of patients with peripheral arterial disease in India. This blog delves more into understanding the causes, symptoms, and treatment options for this condition.

Causes

Research indicates strong connections with the following causes:

• Consumption of tobacco can cause inflammation at the site of tobacco exposure, which may lead to clot formation, leading to decreased blood flow. The chemicals present in any type of tobacco can cause damage to the blood vessels.
• Chian smoking can also increase the risk of disease, as the chemicals present in any form of cigars may cause damage to the blood vessels.
• Experts also indicate that genes or mutations are suspected of linking with Buerger’s disease.  
• The condition can also occur when the body’s immune system is compromised.  

Phases of Buerger’s Disease

Buerger disease is categorised into acute, subacute, and chronic phases based on the clot and inflammation.

• Acute phase: In this phase, a blood clot occurs, which turns to thrombus formation. This may trigger blood vessel wall inflammation due to the increased production of white blood cells called polymorphonuclear (PMN) leukocytes.
• Subacute phase: In this phase, the polymorphonuclear (PMN) leukocytes PMNs are present in small pockets of infection called micro abscesses surrounded by different inflammatory cells, producing an immune response called granulomatous inflammation. This type of inflammatory response is considered long-lasting; it is like the body forming a barrier to keep the problem contained.
• Chronic (End-stage) phase: Over time, the clot is replaced by fibrous tissue where the thrombus becomes organised, and the blood vessel is blocked by stiff and scar tissue. This stage might look like atherosclerosis or other conditions of blood vessels. Unlike atherosclerosis, which mainly affects the internal layers of the blood vessels, Buerger disease affects all three layers, and an internal elastic layer of the blood vessel remains intact.

Symptoms

Buerger disease commonly affects blood vessels in arms and legs, causing swelling and pain due to blockage of blood supply. This may eventually lead to tissue damage, causing tissue death or decay. The most common symptoms of due to this condition:

• Numbness or feeling cold to touch fingers or toes  
• Severe pain, burning, and tingling sensation in hands and feet, which even persist during rest
• Intermittent claudication resulting in muscle cramps, especially in the calf caused by poor blood flow, is a common sign of Buerger’s disease
• Skin colour changes in the fingers or toes, appearing with red, blue or pale discolouration
• Poor circulation can result in open sores or wounds on the toes, feet, or fingers

Diagnosis

No specific diagnosis is available for Buerger’s disease. Comprehensive diagnosis should be completed to rule out other causes, such as thrombophilic states, diabetes, and autoimmune diseases. Some of the tests include:

• Comprehensive serology
• Plethysmography measures the changes in the air or fluid volume within an organ or whole body.  
• Doppler ultrasound of the extremity
• Catheter-based X-ray arteriogram

Treatment

There is no definitive therapy for Buerger’s disease. The treatment mainly deals with healing the symptoms and preventing the condition from worsening. Here are some of the measures and treatments followed.

• Cessation of smoking: Quitting smoking or tobacco is the key to controlling the disease. Some of the treatments that help to stop smoking are being recommended. In addition, avoiding cold temperatures and other things that reduce blood flow to the hands and feet is also important.
• Warm therapy and exercises: To improve circulation, applying warm therapy and doing gentle exercises can be helpful.  
• Medications: Medications like aspirin and vasodilators (which open up blood vessels) and calcium channel blockers may be prescribed to treat blood clots. To treat pain and ischemic complications, prostaglandin analogues such as intravenous iloprost can be used.
• Surgery: Restoring blood flow to the blocked organs, called surgical revascularisation, is often ineffective for Buerger’s disease. Distal lump amputation is the ultimate surgical treatment for patients who cannot quit smoking or in case of non-healing ulcers and gangrene.  

Conclusion

While there is no cure for Buerger’s disease, its symptoms can be managed by a team of healthcare professionals, including a vascular surgeon, a primary care provider, a nurse practitioner, a pain specialist, and an internist. Surgery is rarely used as a treatment, but the most crucial step is quitting smoking, which is essential to control the disease.