Buerger’s Disease (Thromboangiitis Obliterans)

What Is Buerger’s Disease?

Buerger’s disease is a rare illness that inflames and blocks blood vessels in your arms and legs. This stops blood flow and leads to clots that affect your hands and feet.

Doctors also call it thromboangiitis obliterans, or TAO.

There’s no cure for Buerger’s disease. Almost everyone who gets it uses tobacco, including cigarettes, cigars, chewing tobacco, and snuff. Quitting can make the symptoms improve or go away completely. If you don’t quit, you might have severe tissue damage. You could even lose your fingers, toes, or parts of your limbs.

Causes of Buerger’s Disease

Doctors aren’t sure exactly what causes this condition. Your genes might play a role. Some people may just be more likely to get it.

Some experts think that certain chemicals in tobacco might irritate your blood vessels, and that’s what makes them swell. Others think tobacco triggers your immune system to attack your blood vessels like they’re bad germs.

Buerger’s Disease Symptoms

Usually, the first sign of Buerger’s disease is pain in your hands or feet that spreads to your arms and legs. It may be severe. You can get it when you’re active (called claudication) or resting. It can be worse when you’re cold or stressed.

You might also notice changes in your hands and feet. They may:

  • Feel cold, numb, or tingly
  • Look pale, red, or blue in color
  • Have thin, shiny skin
  • Have less hair than usual

Your fingers and toes might:

  • Get painful open sores
  • Turn pale when you’re cold (Raynaud’s phenomenon)

You could also have swelling along a vein just under your skin. This is usually a sign of a blood clot. See your doctor right away.

Buerger’s Disease Complications

Over time, Buerger’s disease can slow -- and completely stop -- the blood flow to your fingers and toes. This can cause gangrene, which means the skin and tissue in your toes and fingers start to die. They go numb and turn blue or black.

If you have gangrene, your doctor usually has to cut off the affected area.

In rare cases, Buerger’s disease can cause a stroke or heart attack.

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Buerger’s Disease Diagnosis

No single test can check for Buerger’s disease. Your doctor will start by asking about your tobacco use and your symptoms.

They may do tests to check your blood flow and rule out other diseases that cause similar symptoms. For example, peripheral artery disease also causes pain in your legs, but it’s caused by plaque building up in your arteries, not inflammation.

You may also have:

  • The Allen test. This is a basic blood flow test. First, you squeeze your hand into a hard fist, which pushes blood out of your hand. Your doctor then presses on the arteries of your wrist to slow the flow of blood back into your hand. At this point, your hand will lose color. When you open your hand, your doctor releases the pressure over the artery on one side of your wrist and then the other side. If it takes a while for your hand to go back to its usual color, it may be a sign of Buerger’s disease.
  • Angiogram. This is a type of X-ray that checks for blocked blood vessels in your arms and legs. Your doctor places a thin tube, called a catheter, into your artery. They pump dye into the artery and quickly take X-rays to get a look at your blood vessels. A CT or MRI scan can make similar pictures.
  • Blood tests. These help your doctor rule out other diseases. They may want to check for conditions like diabetes, lupus, and those that cause blood clots.

Buerger’s Disease Treatment

Quitting tobacco is the only way to limit the effects of Buerger’s disease. Even a few cigarettes a day can make it worse.

Other treatments may help boost blood flow and ease pain, including:

  • Medications such as vasodilators to widen your blood vessels or others to dissolve clots
  • Walking exercises
  • Intermittent compression of your arms and legs
  • Surgery to cut nerves to an affected area (sympathectomy)

Your doctor might need to cut off part or all of an area with infection or gangrene (amputation).

Researchers are also studying other treatments. Proteins called growth factors might speed healing and ease pain. Injections of stem cells, which can grow into other kinds of cells, may help your body make new blood vessels.

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Buerger’s Disease Prognosis

Your outlook depends on whether you quit tobacco. Of patients who keep using it, about 43% will have an amputation within 8 years of diagnosis. Of those who quit, about 6% have an amputation. That percentage is close to 0 in people who are diagnosed early on.

If you’re having a hard time quitting, talk to your doctor about programs that might help.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on February 25, 2020

Sources

SOURCES:

CDC: “Health Effects of Cigarette Smoking.”

CDC: “Smoking and Buerger’s Disease.”

Mayo Clinic: “Buerger’s Disease.”

The Johns Hopkins Vasculitis Center: “Buerger’s Disease.”

UC Davis Vascular Center: “Buerger’s Disease (Thromboangitis Obliterans).”

National Organization of Rare Disorders: “Buerger’s Disease.”

Vasculitis Foundation: “Buerger’s Disease.”

Penn Medicine: “Buerger’s Disease (Thromboangitis Obliterans).”

UpToDate: “Thromboangiitis Obliterans (Buerger’s disease).”

NYU Langone Health: “Types of Vasculitis.”

ePlasty, Open Access Journal of Plastic Surgery: “Thromboangiitis Obliterans (Buerger’s Disease).”

National Center for Advancing Translational Sciences Genetic and Rare Diseases Information Center: “Buerger disease.”

Medscape: “Thromboangiitis Obliterans (Buerger Disease).”

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