Thromboangiitis obliterans

Causes

Thromboangiitis obliterans (Buerger disease) is caused by small blood vessels that become inflamed and swollen. The blood vessels then narrow or become completely blocked by blood clots (thrombosis). Blood vessels of the hands and feet are especially 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 - 40, who are heavy smokers or chew tobacco. Only 1 of 10 patients are women. Many patients also have very poor dental hygiene, likely due to tobacco use.

This disorder is very uncommon in children. It can occur in children with autoimmune diseases.

Symptoms

• Fingers or toes can be pale, red, or bluish and feel cold
• Pain in the hands and feet
  • Acute, severe
  • Burning or tingling
  • Often occurring at rest
  • May be worse with cold exposure or with emotional stress
• Pain in the legs, ankles, or feet when walking (intermittent claudication), often located in the arch of the foot  
• Skin changes or small painful ulcers on fingers or toes
• Usually two or more limbs are affected

Exams and Tests

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

• Special ultrasound of the extremity called plethysmographyy
• 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. 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 to prevent the disease from getting worse.

The patient must stop using tobacco. It is also important to avoid cold temperatures and other conditions that reduce blood flow in the hands and feet.

Applying warmth and exercising gently can help increase circulation.

Aspirin and medications that open the blood vessels (vasodilators) may help. In severe cases, surgery to cut the nerves to the area (surgical sympathectomy) can helpcontrol pain.

If the area becomes so infected that tissue dies, it can be necessary to amputate the fingers or toes.

Outlook (Prognosis)

Symptoms of thromboangiitis obliterans may disappear if the person stops tobacco use. Persons who continue to use tobacco may need repeated amputations of affected fingers or toes.

Possible Complications

• 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

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

Alternative Names

Buerger disease

References

Dargon PT, Landry GJ. Buerger's disease. Ann Vasc Surg. 2012;26(6):871-80.

Olin JW. Other peripheral arterial diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 80.

Update Date: 11/10/2012

Updated by: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.