Introduction:
Buerger’s disease, or thromboangiitis obliterans, is a disease that affects the small and medium-sized blood vessels of the body. It causes inflammation and leads to clot formation in the blood vessels, restricting blood flow to the affected area. The symptoms due to these changes start gradually and cause pain and discomfort to the patient. Smokers are at a high risk of developing Buerger’s disease. No specific treatment protocol is available to those affected by Buerger’s disease. Prevention is the only strategy employed in these patients.
What Is Buerger's Disease?
Buerger’s disease is an inflammatory condition that affects the blood vessels of the legs, feet, arms, and hands. It mainly occurs in the age group between 20 to 40 years, and men are more frequently affected than women. It is also more commonly associated with smokers. Hence, men who smoke are at a greater risk. Due to the inflammatory process, the blood flow through the affected vessels is restricted, leading to blood clot formation. This causes damage to the affected part, starting from the tip of the fingers and extending to the toes.
What Are the Causes of Buerger's Disease?
The exact cause of the disease is not known, but it is found that the tobacco within the cigarette affects the lining of the blood vessels. This increases clot formation within the blood vessels, which leads to a lack of nutrients and oxygen reaching the affected part. It is also found that an immunological reaction is a cause of the disease. Antibodies may start forming against the blood vessels that attack them and cause damage. In a few cases, arsenic poisoning is also a condition that leads to Buerger's disease.
What Are the Symptoms of Buerger's Disease?
The symptoms of Buerger’s disease include:
-
Pain in the leg and ankle region on walking or exercising.
-
Pain starts in the hands and legs and spreads across other body parts.
-
The skin becomes discoloured, and the texture changes.
-
Ulcers begin to develop in the affected areas and progress to form gangrene (death of the cells and tissues) if left untreated.
-
The fingers and toes turn red, blue, or pale.
-
Feeling of numbness or tingling sensations in the affected part.
-
The extremities become cold and clammy.
-
Muscle cramps.
-
Raynaud’s phenomenon is also present. It is a condition wherein the hands and feet turn pale white when exposed to a cold environment.
The symptoms mentioned above do not occur simultaneously. It usually starts with pain and then progresses to ulcer and gangrene formation if not treated early. Hence, the doctor must be consulted as soon as the changes appear.
Who Is More Likely to Develop Buerger's Disease?
The individuals who are at a higher risk of developing Buerger’s disease are as follows:
-
Smokers: Almost all forms of tobacco, like a cigarette, cigars, chewing tobacco, or hand-rolled cigarette with raw tobacco, are linked with the development of Buerger’s disease. People smoking more than one pack of cigarettes per day have the highest risk. It is common in areas of heavy smoking, such as the Mediterranean, the Middle East, and Asia.
-
Age and Sex: Men who come under the age group of 20 to 40 years, along with the habit of smoking, are the most commonly affected individuals. Sometimes, females and those above 50 may also develop the disease.
-
Gum Infection: Smokers are always associated with stains on their teeth and poor oral hygiene. This leads to inflammation of their gums that, if present for a prolonged period, may cause Buerger’s disease.
How to Diagnose Buerger's Disease?
The doctor runs a series of tests before concluding that the individual suffers from Buerger’s disease. A thorough physical examination of the whole body and the affected area is performed. The doctor checks the signs of the disease, such as skin discolouration, ulcer, or gangrene formation. A complete history regarding the habit of continuous smoking and underlying medical conditions are noted. After recording the history, a few imaging tests are done to confirm the diagnosis.
-
Imaging Tests: It includes ultrasound, CT (computed tomography) scan, MRI (magnetic resonance imaging) scan, and arteriography. An arteriogram is a scan of the arteries showing narrowing and obstruction of the arteries near the hands and feet. It has the characteristic ‘pigtail’ or ‘corkscrew’ appearance.
-
Laboratory Tests: Thesecan be performed to eliminate the possibility of diabetes, diseases related to restricted blood flow, and other immunocompromised conditions.
-
Biopsy: A sample of affected tissues collected for a detailed examination of the affected area is collected and observed under a microscope to confirm the diagnosis of Buerger’s disease.
What Is the Treatment for Buerger's Disease?
Until now, there is no specific treatment plan for the patient affected by Buerger’s disease. Quitting the habit of smoking is considered the cornerstone of management. The disease can be controlled by providing medications that relieve the symptoms.
-
The doctor prescribes vasodilators that help dilate the arteries and improve the blood flow. ILOPROST, a prostaglandin analogue, is administered intravenously to decrease pain and arterial obstruction. This drug significantly slows down the progression of the disease and lowers the risk of developing complications like amputation (surgical removal) of the affected part.
-
For pain relief, the doctor prescribes painkillers and antibiotics to reduce the infection. The hands and feet must be kept warm to prevent the development of Raynaud's phenomenon.
-
Hyperbaric oxygen therapy wherein 100% oxygen is administered to the affected area, is an adjunctive treatment if the patient has underlying medical conditions such as diabetes and severe infection of the soft tissues.
-
Surgical treatment is usually avoided in individuals with Buerger’s disease. If the condition worsens, leading to gangrene, then surgical removal of the affected part is performed. Buerger’s disease worsens when the individual continues to smoke without quitting the habit.
What Are the Complications of Buerger's Disease?
The complications develop if the condition is left untreated or when the patient does not quit smoking. The possible complications are amputation, severe infection, gangrene, heart attack, and stroke.
Conclusion:
Buerger’s disease is a rare condition that occurs mostly in men with a habit of smoking. It also affects women, but the ratio is less. The treatment for the disease is preventing the progression and providing symptomatic relief. Surgery is not a definite indication for these patients, and the doctor tries as much as possible to avoid amputation of the affected limb. Hence, the key to controlling the disease is stopping smoking and consuming the medications prescribed by the doctor.
