Also known as thromboangiitis obliterans, Buerger disease is a rare type of peripheral arterial disease that involves inflammation of the smaller and midsize arteries in the extremities. It is a progressive condition associated almost exclusively with tobacco use (smoking or smokeless tobacco), especially among young men. As it worsens, people tend to feel increasing pain in their legs (claudication), particularly after exertion.

Unless people are very careful to keep their hands and feet warm in the cold and to exercise the affected area of their body, severe cases can lead to tissue death (necrosis) and amputation. The disease is extremely rare among nonsmokers. The only known treatment is to quit smoking, after which patients can expect dramatic improvement if irreparable harm has not already occurred.

Also known as thromboangiitis obliterans, Buerger disease is a rare type of peripheral vascular disease that follows three distinct phases. First, there is inflammation in the smaller arteries in the extremities (vasculitis), which leads to the formation of small blood clots. In the second phase, the blood clots organize and grow larger. By the third phase, the inflammation subsides, leaving only the widespread blood clots and scarring of the arterial wall. At this point, the disease is indistinguishable from other arterial diseases, including atherosclerosis, although Buerger is not an atherosclerotic disease. As a result, the symptoms of Buerger's may be hard to distinguish from other vascular diseases. Pain, caused by reduced blood flow, may occur in the legs (claudication) and worsen during exertion and lead to ulceration or more serious tissue damage or death (gangrene). In extreme cases, the fingers, toes or an even larger section of the extremities must be amputated.

This condition was first identified in 1908. The vast majority of people with Buerger’s disease are male smokers, particularly between the ages of 20 and 40. The disease is extremely rare among nonsmokers, suggesting that smoking is a chief cause of the condition, although it may also be associated with a history of Raynaud syndrome. It is thought that the use of tobacco products (including, in rare cases, smokeless tobacco) exacerbates this condition by causing blood vessel spasms or the onset of an autoimmune response, in which the body begins to destroy its own tissue. It is more prevalent in countries with high rates of smoking, especially in the Far East and Middle East, and seems to be especially common among people who smoke homemade cigarettes.

Signs and symptoms of Buerger disease include:

• Limb pain (claudication), which may occur during exertion, such as walking, or while at rest
  
  
• Numbness or tingling in the arms, legs, hands or feet
  
  
• Ulcers on the hands or feet
  
  
• A white or bluish tinge to the skin on the hands or feet, similar to that seen in Raynaud syndrome
  
  
• Extremities that are cold to the touch

The symptoms may worsen with exposure to cold or emotional stress. They usually appear in two or more limbs.

There is no laboratory test that will definitively diagnose Buerger’s disease. Instead, physicians diagnose Buerger’s disease from the array of symptoms presented and from compiling a thorough medical history, with special attention paid to smoking status. Buerger's disease can reasonably be suspected in smokers who suffer from lack of blood flow in their extremities. The diagnosis will also include with a complete examination, which may reveal physical symptoms such as those listed above, and sensitivity in the hands and feet. Blood tests will most likely be ordered.

Buerger’s disease usually involves the presence of blood clots in arteries and veins of the legs and feet, so if the disease is suspected, a physician might next order an angiogram of the peripheral blood vessels. 

In this catheter–based test, a special contrast dye is injected into the bloodstream to allow the doctor to obtain x-ray images of the blood vessels and assess how well they are functioning. It is common for physicians to test for blood clots in all extremities, even if symptoms occur in only one because the disease is typically widespread. Another test that may be useful is a Doppler ultrasound, which produces images of the blood vessels and the blood flow through them.

During the diagnosis, it is important that a cardiac source of the blood clots be ruled out. To do this, physicians might order more tests, such as an echocardiogram, to evaluate the health of the heart.

There is no treatment for Buerger’s disease, other to quit smoking immediately, after which patients can expect dramatic improvement if irreparable harm has not already occurred. In the meantime, physicians will also attempt to treat the pain, usually with aspirin or other painkillers.

If there is ulceration or dead tissue, then revascularization techniques may be performed to help restore adequate blood flow and prevent amputation. This procedure is rare, however, because the disease usually affects such a widespread area of the circulatory system.

To prevent tissue death, patients are encouraged to keep their hands and feet well protected in cold weather and to regularly exercise affected areas to improve circulation.

Because smoking is the chief cause of Buerger disease, the best way to prevent this progressive and untreatable condition is to quit smoking and avoid all second–hand smoke.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their treatment options. The following questions related to Buerger disease may be helpful:

1. Could I have developed this condition as a result of smoking?
   
   
2. How advanced is my condition? Has any irreparable harm been caused by my condition?
   
   
3. Are there any lifestyle changes that could improve my condition?
   
   
4. Are there any medications or other therapies available to treat my condition?
   
   
5. How urgently do I need to quit smoking?
   
   
6. What type of improvements can I expect to see if I quit smoking?
   
   
7. Can you recommend any resources to help me quit smoking?
   
   
8. How important is it that I exercise regularly?
   
   
9. Do I need to be careful to keep my hands and feet warm in cold weather?
   
   
10. Could Buerger disease interfere with my pregnancy in any way?