Arellano University

College of Nursing

BUERGER’S DISEASE

Gerlie D. delos Santos

Sec.7- Cardiotonics
Buerger’s Disease
Buerger's disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms
and legs. In Buerger's disease, your blood vessels swell and can become blocked with blood clots
(thrombi). This eventually damages or destroys skin tissues and may lead to infection and gangrene.
Buerger's disease usually first shows in the hands and feet and may expand to affect larger areas of
your arms and legs.

Buerger's disease is rare in the United States, but is more common in the Middle East and Far East.
Buerger's disease usually affects men between ages 20 and 40, though it's becoming more common in
women.

Virtually everyone diagnosed with Buerger's disease smokes cigarettes or uses other forms of tobacco,
such as chewing tobacco. Quitting all forms of tobacco is the only way to stop Buerger's disease. For
those who don't quit, amputation of all or part of a limb may ultimately be necessary.

Symptoms

Buerger's disease symptoms include:

 Pain and weakness in your legs and feet or your arms and hands
 Swelling in your feet and hands
 Fingers and toes that turn pale when exposed to cold (Raynaud's phenomenon)
 Open sores on your fingers and toes
 Temperature changes in affected areas
 Ulceration and gangrene

Causes

 It isn't clear what triggers Buerger's disease. The condition is caused by swelling in the
arteries and veins of the arms and legs. The cells that cause the swelling — and eventually
blood clots — form in the vessels leading to your hands and feet and block the blood flow to
those parts of your body.
 Reduced blood flow means that the skin tissue in your hands and feet doesn't get adequate
oxygen and nutrients. This leads to the signs and symptoms of Buerger's disease, beginning
with pain and weakness in your fingers and toes and spreading to other parts of your arms and
legs.

Risk factors

Tobacco use
Cigarette smoking greatly increases your risk of Buerger's disease. Heavy cigarette smokers (people
who smoke one and a half packs a day or more) are most likely to develop Buerger's disease, though it
can occur in people who use any form of tobacco, including cigars and chewing tobacco. People who
smoke hand-rolled cigarettes using raw tobacco may have the greatest risk of Buerger's disease.

It isn't clear how tobacco use increases your risk of Buerger's disease, but virtually everyone
diagnosed with Buerger's disease uses tobacco. It's thought that chemicals in tobacco may irritate the
lining of your blood vessels, causing them to swell.
Complications

If Buerger's disease worsens, blood flow to your arms and legs decreases. This is due to blockages
that make it hard for blood to reach the tips of your fingers and toes. Tissues that don't receive blood
don't get the oxygen and nutrients they need to survive. This can cause the skin and tissue on the ends
of your fingers and toes to die (gangrene). Signs and symptoms of gangrene include black or blue
skin, a loss of feeling in the affected finger or toe and a foul smell from the affected area. Gangrene is
a serious condition that usually requires amputation of the affected finger or toe.

Tests and diagnosis

The doctor will ask you about your signs and symptoms. No tests can confirm whether you have
Buerger's disease. Instead, your doctor will likely order tests to rule out other more common
conditions. These tests may include:

Blood tests
Blood tests 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.

The Allen's test

Your doctor may conduct a simple test called the Allen's test to check blood flow through the arteries
carrying blood to your hands. In the Allen's test, you make a tight fist, which forces the blood out of
your hand. Your doctor presses on the arteries at each side of your wrist to slow the flow of blood
back into your hand, making your hand lose its normal color. Next, you open your hand and your
doctor releases the pressure on one artery then the other. How quickly the color returns to your hand
may give a general indication about the health of your arteries. Slow blood flow into your hand may
indicate a problem, such as Buerger's disease.

Angiogram
An angiogram, also called an arteriogram, helps doctors see the condition of your arteries. Doctors
inject dye into an artery and then take X-rays or other types of images. Images show any blockages in
the artery. Your doctor may order arteriograms be performed on both of your arms and your legs —
even if you don't have signs and symptoms of Buerger's disease in all of your limbs. Buerger's disease
almost always affects more than one limb, so even though you may not have signs and symptoms in
your other limbs, this test may detect early signs of vessel damage

Biopsy of unaffected blood vessels

Anatomy and Physiology

Pathophysiology

The disease is typically encountered in heavy smokers, often before the age of 35 years.

Thromboangiitis obliterans is marked by segmental thrombosing, acute, and chronic inflammation of

intermediate and small arteries and veins in the extremities.

It begins with nodular phlebitis, followed by Raynaud's-like cold sensitivity and leg claudication.

Acute lesions consist of neutrophilic infiltration of the arterial wall, with mural or occlusive thrombi
containing microabscesses, often with giant cell formation and secondary involvement of the
adjacent vein and nerve.

Late lesions show organization and recanalization.

The cause is unknown.

The vascular insufficiency can lead to excruciating pain and ultimately gangrene of the extremities.

Treatment

A person with this disease must stop smoking, or it will relentlessly worsen, and
ultimately an amputation may be necessary. Also, the person should avoid exposure to
the cold; injuries from heat, cold, or substances such as iodine or acids used to treat
corns and calluses; injuries from poorly fitting shoes or minor surgery (such as trimming
calluses); fungal infections; and drugs that can narrow blood vessels.

Walking 15 to 30 minutes twice a day is recommended, except for people with gangrene,
sores, or pain at rest; they may need bed rest. People should protect their feet with
bandages that have heel pads or with foam-rubber booties. The head of the bed can be
raised on 6- to 8-inch blocks so gravity helps blood flow through the arteries. Doctors
may prescribe pentoxifylline, calcium antagonists, or platelet inhibitors such as aspirin,
especially when the obstruction results from spasm.

For people who quit smoking but still have arterial occlusion, surgeons may improve
blood flow by cutting certain nearby nerves to prevent spasm. They seldom perform
bypass grafts, because the arteries affected by this disease are too small.