Buerger Disease

Buerger disease is also known as thromboangiitis obliterans. It is an inflammatory condition that causes thrombus formation in the small and medium-sized blood vessels in the distal arterial system (affecting the hands and feet). 

Buerger disease typically affects men aged 25 – 35 and has a very strong association with smoking. 

Notable features (included in the diagnostic criteria) are:

  • Younger than 50 years
  • Not having risk factors for atherosclerosis, other than smoking 

 

Presentation

The typical presenting feature is painful, blue discolouration to the fingertips or tips of the toes. The pain is often worse at night. This may progress to ulcers, gangrene and amputation.

Corkscrew collaterals are a typical finding on angiograms, where new collateral vessels form to bypass the affected arteries.

 

Management

Completely stopping smoking is the main component of treatment. This usually results in a significant improvement. Cutting down or using nicotine replacement products does not seem to be adequate to improve the condition.

Other specialist treatments may be considered, including intravenous iloprost (a prostacyclin analogue that dilates blood vessels).

TOM TIP: The key presentation to remember for your exams is a young male smoker with painful blue fingertips. The exam question may ask the diagnosis (Buerger disease or thromboangiitis obliterans) or ask the most important aspect of management (completely stopping smoking).

 

Last updated May 2021
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