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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 get blocked by blood clots (thrombosis). Blood vessels of the hands and feet are mostly affected. Arteries are more affected than veins. Average age when symptoms begin is around 35. Women and older adults are affected less often.

This condition mostly affects young men ages 20 to 45 who are heavy smokers or chew tobacco. Female smokers in Western countries may also be affected. Many people with this problem have poor dental health, most likely due to tobacco use.

 

Symptoms

 

Symptoms most often affect 2 or more limbs and may include:

  • Fingers or toes that appear pale, red, or bluish and feel cold to the touch.
  • Sudden severe pain in the hands and feet. The pain may feel like a burning or tingling.
  • Pain in the hands and feet that most often occurs when at rest. The pain may be worse when the hands and feet get cold or during emotional stress.
  • Pain in the legs, ankles, or feet when walking (intermittent claudication). The pain is often located in the arch of the foot.
  • Skin changes or small painful ulcers on the fingers or toes.

 

Exams and Tests

 

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

  • Ultrasound of the extremity, called plethysmography
  • Doppler ultrasound of the extremity

Blood tests for other causes of inflamed blood vessels (vasculitis) and blocked (occlusion of) blood vessels may be done. These causes include diabetes, scleroderma, and atherosclerosis. There are no blood tests that diagnose thromboangiitis obliterans.

A heart echocardiogram may be done to look for sources of blood clots. 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 prevent the disease from getting worse.

Stopping tobacco use of any kind is key to controlling the disease. Smoking cessation treatments are strongly recommended. It is also important to avoid cold temperatures and other conditions that reduce blood flow in the hands and feet.

Applying warmth and doing gentle exercises can help increase circulation.

Aspirin and medicines that open the blood vessels (vasodilators) may help. In very bad cases, surgery to cut the nerves to the area (surgical sympathectomy) can help control pain.

It may become necessary to amputate the fingers or toes if the area becomes very infected and tissue dies.

 

Outlook (Prognosis)

 

Symptoms of thromboangiitis obliterans may go away if the person stops tobacco use. People who continue to use tobacco may need repeated amputations.

 

Possible Complications

 

Complications include:

  • 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

 

People with a history of Raynaud phenomenon or blue, painful fingers or toes, especially with ulcers, should not use any form of tobacco.

 

 

References

Akar AR, Durdu S. Thromboangiitis obliterans. In: Cronenwett JL, Johnston KW, eds. Rutherford's Vascular Surgery. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 79.

Stone JH. The systemic vasculitudes. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 270.

 
  • Thromboangiites obliterans

    Thromboangiites obliterans - illustration

    Thromboangiitis obliterans is a disorder that leads to obstruction of the blood vessels of the hands and feet. The blood vessels become constricted or totally obstructed because of the inflammation and clots which reduces the availability of blood to the tissues. Thromboangiitis obliterans almost always affects men, 20 to 40 years old, who have a history of smoking or chewing tobacco.

    Thromboangiites obliterans

    illustration

  • Circulatory system

    Circulatory system - illustration

    Blood used by the body is brought back to the heart and lungs by the veins of the body. Once the blood has gathered more oxygen from the lungs, it is pumped back out to the body through the arteries.

    Circulatory system

    illustration

    • Thromboangiites obliterans

      Thromboangiites obliterans - illustration

      Thromboangiitis obliterans is a disorder that leads to obstruction of the blood vessels of the hands and feet. The blood vessels become constricted or totally obstructed because of the inflammation and clots which reduces the availability of blood to the tissues. Thromboangiitis obliterans almost always affects men, 20 to 40 years old, who have a history of smoking or chewing tobacco.

      Thromboangiites obliterans

      illustration

    • Circulatory system

      Circulatory system - illustration

      Blood used by the body is brought back to the heart and lungs by the veins of the body. Once the blood has gathered more oxygen from the lungs, it is pumped back out to the body through the arteries.

      Circulatory system

      illustration

    Tests for Thromboangiitis obliterans

     

       

      Review Date: 7/21/2016

      Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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