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    Thromboangiitis obliterans

    Buerger disease

    Thromboangiitis obliterans is a rare disease in which blood vessels of the hands and feet become blocked.

    Causes

    Thromboangiitis obliterans (Buerger disease) is caused by small blood vessels that become inflamed and swollen. The blood vessels then narrow or become completely blocked by blood clots (thrombosis). Blood vessels of the hands and feet are especially affected. Arteries are more affected than veins. Average age when symptoms begin is around 35. Women and older adults are affected less often.

    Thisconditionmostly affects young men ages 20- 40, whoare heavy smokers or chew tobacco. Only 1 of 10 patients are women. Many patients also have very poor dental hygiene, likely due to tobacco use.

    This disorder is very uncommon in children.It canoccur in children with autoimmune diseases.

    Symptoms

    • Fingersortoes canbe pale, red, or bluish and feel cold
    • Pain in the hands and feet
      • Acute, severe
      • Burning or tingling
      • Often occurring at rest
      • May be worse with cold exposure or with emotional stress
    • Pain in the legs, ankles, or feet when walking (intermittent claudication),often located in the arch of the foot
    • Skin changes or small painful ulcers onfingers or toes
    • Usually two or more limbs are affected

    Exams and Tests

    The following tests may show blockage of blood vessels in the affected hands or feet:

    • Special ultrasound of the extremity called plethysmographyy
    • Doppler ultrasound of the extremity

    Blood tests for other causes of inflamed blood vessels(vasculitis) andblocked (occlusion of) blood vesselsmay be done. These causes include diabetes, scleroderma, and atherosclerosis. In rare cases when the diagnosis is unclear, a biopsy of the blood vessel is done.

    Treatment

    There is no cure for thromboangiitis obliterans. The goal of treatment is to control symptoms and to prevent the disease from getting worse.

    The patient must stop using tobacco. It is also important to avoid cold temperatures and other conditions that reduce bloodflowin the hands and feet.

    Applying warmth and exercising gentlycan help increase circulation.

    Aspirin and medications that open the blood vessels (vasodilators) may help. In severe cases, surgery to cut the nerves to the area (surgical sympathectomy) can helpcontrol pain.

    If the area becomes so infected that tissue dies, it can be necessary to amputate the fingers or toes.

    Outlook (Prognosis)

    Symptoms of thromboangiitis obliterans may disappear if the person stops tobacco use. Persons who continue to use tobacco may need repeated amputations of affected fingersor toes.

    Possible Complications

    • Tissue death (gangrene)
    • Amputation of fingers or toes
    • Loss of blood flow in the limb of the affected fingers or toes

    When to Contact a Medical Professional

    Call your health care provider if:

    • You have symptoms of thromboangiitis obliterans
    • You have thromboangiitis obliterans and symptoms get worse, even with treatment
    • You develop new symptoms

    Prevention

    Persons with a history of Raynaud disease or blue, painful fingers or toes, especially with ulcers, shouldnot use any form oftobacco.

    References

    Dargon PT, Landry GJ. Buerger's disease. Ann Vasc Surg. 2012;26(6):871-80.

    Olin JW. Other peripheral arterial diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 80.

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    • Thromboangiites oblitera...

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    • Circulatory system

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      • Thromboangiites oblitera...

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      • Circulatory system

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      Tests for Thromboangiitis obliterans

        Review Date: 11/10/2012

        Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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