BUERGER’S DISEASE – Causes and Risk Factors, Signs and Symptoms, Diagnostic Evaluations and Management
BUERGER’S DISEASE – Causes and Risk Factors, Signs and Symptoms, Diagnostic Evaluations and Management
Buerger’s disease (thromboangitis obliterans) is characterized by clotting or thrombosis and acute recurring inflammation of the small and medium sized arteries and veins of the feet and hands leading to restricted blood flow. If Buerger’s disease left untreated, it can lead to gangrene of the affected areas.
Most commonly lower extremities are involved rarely is the involvement of the upper extremities. It is generally bilateral and symmetric with focal lesions. Superficial thrombophlebitis may also be present.
CAUSES AND RISK FACTORS
The exact cause of Buerger’s disease is unknown, it is autoimmune and that causes vasculitis. Buerger’s disease most likely affects people who are in between 20 to 40 years of age. The chance of men getting affected by this disease is three times more than the women. It is seen that heavy smokers develop this disease more than the other people. It’s possible that some people may have a genetic predisposition to the disease. The consumption of tobacco in any form i.e. by smoking cigarette or chewing tobacco increases the chance of developing this disease. It is also seen that people having digestive disorders may also acquire this disease. Approximately 40% of the patients have a history of inflammation of a vein (phlebitis).
SIGNS AND SYMPTOMS OF BUERGER’S DISEASE
Early symptoms include decrease in the blood supply (arterial ischemia) and superficial (near the skin surface) phlebitis. The main symptom is pain in the affected areas. There may be a sensation of numbness, tingling or burning in the legs. Patients with Buerger’s disease experience weakness, swelling in the hands and feet. Onset of the disease is gradual and first occurs in the feet or hands.
Physical signs include rubor, a sign of inflammation of the foot with reddish blue discoloration and absence of the pedal pulses, femoral and popliteal pulses are normal. Radial and ulnar artery pulses are absent or diminished and parasthesias of different types may develop.
In advanced cases, blood vessels in other part of the body may be affected. There is a progressive decrease in the blood flow to the affected areas. The pulse in arteries of the feet is weak or undetectable. Sometimes one may also experience sores on fingers and toes. The lack of blood flow can lead to gangrene, which is decay of tissue due to restricted blood supply. A cold sensitivity in the hands, similar to that seen in Raynaud’s disease, can develop. In this case, the hands turn color – white, blue, and then red – when exposed to the cold.
DIAGNOSTIC EVALUATIONS
Diagnosis is usually made from the clinical symptoms. Patients frequently complain of numbness, tingling, or burning sensations in the affected area before evidence of vascular inflammation becomes apparent. Blood test is done to look for certain substances can rule out other conditions that may cause similar signs and symptoms. For instance, blood tests can help rule out scleroderma, lupus, blood-clotting disorders and diabetes, along with other diseases and conditions.
Doctor may perform a simple test called the Allen’s test to check blood flow through the arteries carrying blood to hands. In the Allen’s test, patient makes a tight fist, which forces the blood out of hand. Doctor presses on the arteries at each side of wrist to slow the flow of blood back into hand, making hand lose its normal color. How quickly the color returns to hand may give a general indication about the health of arteries. Slow blood flow into hand may indicate a problem, such as Buerger’s disease. An angiogram helps doctors see the condition of arteries. A special dye is injected into an artery, after which patient undergo X-rays or other imaging tests.
MANAGEMENT
Treatment of Buerger’s disease is almost same as that of the peripheral atherosclerotic arterial disease. The main objectives of treatment are to:
- Improve the circulation in the limb
- To protect the extremities from trauma and infection
- Treatment of infections which leads to gangrene is directed toward the minimal debridement and so the limb can be saved from amputation
- Smoking and chewing of tobacco is highly detrimental and can cause exacerbation of claudication attacks. So, stress is given to stop the use of tobacco.
- After the patient stops smoking the symptoms like pain are relieved.
- Patients must stop smoking to halt further development of the symptoms
- Medications such as vasodilators, thrombolytics and anticoagulants to dilate blood vessels, improve blood flow or dissolve blood clots.
- Intermittent compression of the arms and legs to increase blood flow to extremities
- Vascular surgery can sometimes be helpful in treating limbs with poor perfusion
- The use of vascular growth factor (therapeutic angiogenesis) and stem cell injections has also been successful in treating the symptoms of this disease.
- Exposure of affected areas to heat or cold should be avoided. Trauma to the feet and other affected areas should be avoided and infections must be treated promptly
- Amputation, if infection or gangrene occurs
PREVENTION
- Abstain from tobacco use in all forms
- Avoid drugs which constrict the blood vessels
- Gentle massage and warmth to increase circulation
- Avoid injury from heat or cold
- Avoid conditions that reduce circulation to the extremities, such as cold temperatures
- Avoid tight or restrictive clothing
- Avoid sitting or standing in one position for long periods
- Do not walk barefoot in order to avoid injury
- Wear cotton socks/wool socks that will allow feet to breathe and receive adequate ventilation
- Wear soft insoles to help protect the feet and always wear protective foot coverings
- Avoid minor surgery of the toes
- Seek treatment for fungal infections immediately