Buerger disease - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Buerger disease is a nonatherosclerotic vasculitis resulting in segmental occlusions of small and medium-sized arteries.
Highest incidence is in young men of southeast Mediterranean origin and of Middle and Far East origin who smoke.
Presents as an acutely ischemic limb, more commonly affecting the lower limb. Claudication is rarely described.
Laboratory investigations exclude other vascular disease. Appropriate imaging shows medium and small vessel occlusion. Histologic analysis of arterial specimens shows preservation of the internal elastic lamina.
Best outcomes are associated with smoking cessation.

Fingertip ulceration in a woman who smokes

From the collection of Matthew J. Metcalfe and Alun H. Davies

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

Fingertip ulceration in a woman who smokes
A cold ischemic middle finger in a woman who smokes
Subsequent middle finger amputation in a woman who continued to smoke
Subsequent index finger amputation in a woman who continued to smoke

Citations

Key Articles

Lie JT. The rise and fall and resurgence of thromboangiitis obliterans (Buerger's disease). Acta Pathol Jpn. 1989 Mar;39(3):153-8.[Abstract]
Olin JW, Young JR, Graor RA, et al. The changing clinical spectrum of thromboangiitis obliterans (Buerger's disease). Circulation. 1990 Nov;82(5 suppl):IV3-8. [Abstract]
Buerger L. Thrombo-angiitis obliterans: a study of the vascular lesions leading to presenile spontaneous gangrene. Am J Med Sci. 1908 Nov;136(5):567-80.
Papa MZ, Rabi I, Adar R. A point scoring system for the clinical diagnosis of Buerger's disease. Eur J Vasc Endovasc Surg. 1996 Apr;11(3):335-9.[Abstract]
Ohta T, Ishioashi H, Hosaka M, et al. Clinical and social consequences of Buerger disease. J Vasc Surg. 2004 Jan;39(1):176-80.[Abstract]
Cacione DG, Macedo CR, do Carmo Novaes F, et al. Pharmacological treatment for Buerger's disease. Cochrane Database Syst Rev. 2020 May 4;5:CD011033.[Abstract][Full Text]

Other Online Resources

National Health Service. Better health: quit smoking
US Department of Health and Human Services. National Cancer Institute: smokefree.gov

Referenced Articles

1. Mills JL, Porter JM. Buerger's disease (thromboangiitis obliterans). Ann Vasc Surg. 1991 Nov;5(6):570-2.[Abstract]
2. Le Joncour A, Soudet S, Dupont A, et al. Long-term outcome and prognostic factors of complications in thromboangiitis obliterans (Buerger's disease): a multicenter study of 224 patients. J Am Heart Assoc. 2018 Dec 4;7(23):e010677.[Abstract][Full Text]
3. Arkkila PE. Thromboangiitis obliterans (Buerger's disease). Orphanet J Rare Dis. 2006 Apr 27;1:14.[Abstract][Full Text]
4. Lie JT. The rise and fall and resurgence of thromboangiitis obliterans (Buerger's disease). Acta Pathol Jpn. 1989 Mar;39(3):153-8.[Abstract]
5. Olin JW, Young JR, Graor RA, et al. The changing clinical spectrum of thromboangiitis obliterans (Buerger's disease). Circulation. 1990 Nov;82(5 suppl):IV3-8. [Abstract]
6. Zheng JF, Chen YM, Chen DY, et al. The incidence and prevalence of thromboangiitis obliterans in Taiwan: a nationwide, population-based analysis of data collected from 2002 to 2011. Clinics (Sao Paulo). 2016 Jul;71(7):399-403.[Abstract][Full Text]
7. Yorukoglu Y, Ilgit E, Zengin M, et al. Thromboangiitis obliterans (Buerger's disease) in women (a reevaluation). Angiology. 1993 Jul;44(7):527-32. [Abstract]
8. Buerger L. Thrombo-angiitis obliterans: a study of the vascular lesions leading to presenile spontaneous gangrene. Am J Med Sci. 1908 Nov;136(5):567-80.
9. Rahman M, Chowdhury AS, Fukui T, et al. Association of thromboangiitis obliterans with cigarette and bidi smoking in Bangladesh: a case-control study. Int J Epidemiol. 2000 Apr:29(2):266-70.[Abstract][Full Text]
10. Disdier P, Granel B, Serratrice J, et al. Cannabis arteritis revisited - ten new case reports. Angiology. 2001 Jan;52(1):1-5.[Abstract]
11. Allen EV, Brown GE. Thrombo-angiitis obliterans: a clinical study of 200 cases: I. etiology, pathology, symptoms, diagnosis. Ann Intern Med. 1928 Feb;1(8):535-49.
12. Iwai T, Inoue Y, Umeda M, et al. Oral bacteria in the occluded arteries of patients with Buerger disease. J Vasc Surg. 2005 Jul;42(1):107-15.[Abstract]
13. Iwai T. Periodontal bacteremia and various vascular diseases. J Periodontal Res. 2009 Dec;44(6):689-94.[Abstract]
14. Kjeldsen K, Mozes M. Buerger's disease in Israel. Investigations on carboxyhemoglobin and serum cholesterol levels after smoking. Acta Chir Scand. 1969;135(6):495-98.[Abstract]
15. Chen Z, Nakajima T, Inoue Y, et al. A single nucleotide polymorphism in the 3'-untranslated region of MyD88 gene is associated with Buerger disease but not with Takayasu arteritis in Japanese. J Hum Genet. 2011 Jul;56(7):545-7.[Abstract]
16. Makita S, Nakamura M, Murakami H, et al. Impaired endothelium-dependent vasorelaxation in peripheral vasculature of patients with thromboangiitis obliterans (Buerger's disease). Circulation. 1996 Nov 1;94(9 suppl):II211-5.[Abstract]
17. Papa M, Bass A, Adar R, et al. Autoimmune mechanisms in thromboangiitis obliterans (Buerger's disease): the role of tobacco antigen and the major histocompatibility complex. Surgery. 1992 May;111(5):527-31.[Abstract]
18. Dellalibera-Joviliano R, Joviliano EE, Evora PR. Determination of kininogens levels and kallikrein/kininase II activities in patients with thromboangiitis obliterans. Scand J Immunol. 2010 Aug;72(2):128-33.[Abstract]
19. Lie JT. Thromboangiitis obliterans (Buerger's disease) and smokeless tobacco. Arthritis Rheum. 1988 Jun;31(6):812-3.[Abstract]
20. Joyce JW. Buerger's disease (thromboangiitis obliterans). Rheum Dis Clin North Am. 1990 May;16(2):463-70.[Abstract]
21. Maslowski L, McBane R, Alexewicz P, Wysokinski WE. Antiphospholipid antibodies in thromboangiitis obliterans. Vasc Med. 2002;7(4):259-64.[Abstract]
22. Chen YW, Nagasawa T, Wara-Aswapati N, et al. Association between periodontitis and anti-cardiolipin antibodies in Buerger disease. J Clin Periodontol. 2009 Oct;36(10):830-5.[Abstract]
23. Chen Z, Takahashi M, Naruse T, et al. Synergistic contribution of CD14 and HLA loci in the susceptibility to Buerger disease. Hum Genet. 2007 Nov;122(3-4):367-72.[Abstract]
24. Sasaki S, Sakuma M, Kunihara T, et al. Distribution of arterial involvement in thromboangiitis obliterans (Buerger's disease): results of a study conducted by the Intractable Vasculitis Syndromes Research Group in Japan. Surg Today. 2000;30(7):600-5.[Abstract]
25. Puechal X, Fiessinger JN, Kahan A, et al. Rheumatic manifestations in patients with thromboangiitis obliterans (Buerger's disease). J Rheumatol. 1999 Aug;26(8):1764-8.[Abstract]
26. Juergens JL. Thromboangiitis obliterans (Buerger's disease, TAO). In: Juergens JL, Spittel JA, Fairbairn JF, eds. Peripheral vascular disease. Philadelphia, PA: WB Saunders; 1980:469-491.
27. Hill GL. A rational basis for management of patients with Buerger syndrome. Br J Surg. 1974 Jun;61(6):476-81.[Abstract]
28. Puéchal X, Fiessinger JN. Thromboangiitis obliterans or Buerger's disease: challenges for the rheumatologist. Rheumatology (Oxford). 2007 Feb;46(2):192-9.[Abstract][Full Text]
29. Shionoya S. Pathology. In: Shionoya S, ed. Buerger's disease. Nagoya: University of Nagoya Press; 1990:57-79.
30. Papa MZ, Rabi I, Adar R. A point scoring system for the clinical diagnosis of Buerger's disease. Eur J Vasc Endovasc Surg. 1996 Apr;11(3):335-9.[Abstract]
31. Sasajima T, Kubo Y, Inaba M, et al. Role of infrainguinal bypass in Buerger's disease: an eighteen-year experience. Eur J Vasc Endovasc Surg. 1997 Feb;13(2):186-92.[Abstract]
32. Ohta T, Ishioashi H, Hosaka M, et al. Clinical and social consequences of Buerger disease. J Vasc Surg. 2004 Jan;39(1):176-80.[Abstract]
33. Olin JW. Thromboangiitis obliterans (Buerger's disease). N Engl J Med. 2000 Jan;343(1):864-9.[Abstract]
34. Sasaki S, Sakuma M, Yasuda K. Current status of thromboangiitis obliterans (Buerger's disease) in Japan. Int J Cardiol. 2000 Aug 31;75(suppl 1):S175-81.[Abstract]
35. O'Dell JR, Linder J, Markin RS, et al. Thromboangiitis obliterans (Buerger's disease) and smokeless tobacco. Arthritis Rheum. 1987 Sep;30(9):1054-6.[Abstract]
36. Palomo Arellano A, Gomez Tello V, Parilla Herranz P, et al. Buerger's disease starting in the upper extremity: a favorable response to nifedipine treatment combined with stopping tobacco use. An Med Interna. 1990 Jun;7(6):307-8.[Abstract]
37. Agarwal P, Agrawal PK, Sharma D, et al. Intravenous infusion for the treatment of diabetic and ischaemic non-healing pedal ulcers. J Eur Acad Dermatol Venereol. 2005 Mar;19(2):158-62.[Abstract]
38. Ohashi S, Iwatani M, Hyakuna Y, et al. Thermographic evaluation of the hemodynamic effect of the antithrombotic drug cilostazol in peripheral arterial occlusion. Arzneimittelforschung. 1985;35(7A):1203-8.[Abstract]
39. Fiessinger JN, Schafer M. Trial of iloprost versus aspirin treatment for critical limb ischaemia of thromboangiitis obliterans. The TAO study. Lancet. 1990 Mar 10;335(8689):555-7.[Abstract]
40. Bozkurt AK, Koksal C, Demirbas MY, et al. A randomized trial of intravenous iloprost (a stable prostacyclin analogue) versus lumbar sympathectomy in the management of Buerger's disease. Int Angiol. 2006 Jun;25(2):162-8.[Abstract]
41. Cacione DG, Macedo CR, do Carmo Novaes F, et al. Pharmacological treatment for Buerger's disease. Cochrane Database Syst Rev. 2020 May 4;5:CD011033.[Abstract][Full Text]
42. The European TAO Study Group. Oral iloprost in the treatment of thromboangiitis obliterans (Buerger's disease): a double-blind, randomised, placebo-controlled trial. Eur J Vasc Endovasc Surg. 1998 Apr;15(4):300-7.[Abstract][Full Text]
43. National Institute for Health and Care Excellence. Peripheral arterial disease: diagnosis and management. NICE clinical guideline CG147. Dec 2020 [internet publication].[Full Text]
44. Donas KP, Schulte S, Ktenidis K, et al. The role of epidural spinal cord stimulation in the treatment of Buerger's disease. J Vasc Surg. 2005 May;41(5):830-6.[Abstract]
45. Manfredini R, Boari B, Gallerani M, et al. Thromboangiitis obliterans (Buerger disease) in a female mild smoker treated with spinal cord stimulation. Am J Med Sci. 2004 Jun;327(6):365-8.[Abstract]
46. Broseta J, Barbera J, de Vera JA, et al. Spinal cord stimulation in peripheral arterial disease: a cooperative study. J Neurosurg. 1986 Jan;64(1):71-80.[Abstract]
47. Chander J, Singh L, Lal P, et al. Retroperitoneoscopic lumbar sympathectomy for Buerger's disease: a novel technique. JSLS. 2004 Jul-Sep;8(3):291-6.[Abstract]
48. Lau H, Cheng SW. Buerger's disease in Hong Kong: a review of 89 cases. Aust NZ J Surg. 1997 May;67(5):264-9.[Abstract]
49. Kothari R, Sharma D, Thakur DS, et al. Thoracoscopic dorsal sympathectomy for upper limb Buerger's disease. JSLS. 2014 Apr-Jun;18(2):273-6.[Abstract][Full Text]
50. Segers B, Himpens J, Barroy JP. Retroperitoneal laparoscopic bilateral lumbar sympathectomy. Acta Chir Belg. 2007 Jun;107(3):341-2.[Abstract]
51. Hussein EA, el Dorri A. Intra-arterial streptokinase as adjuvant therapy for complicated Buerger's disease: early trials. Int Surg. 1993 Jan-Mar;78(1):54-8.[Abstract]
52. Isner JM, Baumgartner I, Rauh G, et al. Treatment of thromboangiitis obliterans (Buerger's disease) by intramuscular gene transfer of vascular endothelial growth factor: preliminary clinical results. J Vasc Surg. 1998 Dec;28(6):964-73.[Abstract]
53. Morishita R, Shimamura M, Takeya Y, et al. Combined analysis of clinical data on HGF gene therapy to treat critical limb ischemia in Japan. Curr Gene Ther. 2020;20(1):25-35.[Abstract][Full Text]
54. Tateishi-Yuyama E, Matsubara H, Murohara T, et al. Therapeutic angiogenesis for patients with limb ischaemia by autologous transplantation of bone-marrow cells: a pilot study and a randomized controlled trial. Lancet. 2002 Aug 10;360(9331):427-35.[Abstract]
55. Fadini GP, Agostini C, Avogaro A. Autologous stem cell therapy for peripheral arterial disease: meta-analysis and systematic review of the literature. Atherosclerosis. 2010 Mar;209(1):10-7.[Abstract]
56. Idei N, Soga J, Hata T, et al. Autologous bone-marrow mononuclear cell implantation reduces long-term major amputation risk in patients with critical limb ischemia: a comparison of atherosclerotic peripheral arterial disease and Buerger disease. Circ Cardiovasc Interv. 2011 Feb 1;4(1):15-5.[Abstract][Full Text]
57. Cacione DG, do Carmo Novaes F, Moreno DH. Stem cell therapy for treatment of thromboangiitis obliterans (Buerger's disease). Cochrane Database Syst Rev. 2018 Oct 31;10:CD012794.[Abstract][Full Text]
58. Todoli Parra JA, Hernández MM, Arrébola López MA. Efficacy of bosentan in digital ischemic ulcers. Ann Vasc Surg. 2010 Jul;24(5):690.e1-4.[Abstract]
59. Narváez J, García-Gómez C, Álvarez L, et al. Efficacy of bosentan in patients with refractory thromboangiitis obliterans (Buerger disease): a case series and review of the literature. Medicine (Baltimore). 2016 Nov;95(48):e5511.[Abstract][Full Text]
60. Stümpflen A, Ahmadi A, Attender M, et al. Effects of transvenous regional guanethidine block in the treatment of critical finger ischemia. Angiology. 2000;51:115-122.[Abstract]
61. Paraskevas KI, Trigka AA, Samara M. Successful intravenous regional sympathetic blockade (Bier's Block) with guanethidine and lidocaine in a patient with advanced Buerger's Disease (thromboangiitis obliterans) - a case report. Angiology. 2005;56:493-496.[Abstract]
62. Szuba A, Cooke JP. Thromboangiitis obliterans: an update on Buerger's disease. West J Med. 1998 Apr;168(4):255-60.[Abstract][Full Text]
63. Ates A, Yekeler I, Ceviz M, et al. One of the most frequent vascular diseases in northeastern of Turkey: thromboangiitis obliterans or Buerger's disease (experience with 344 cases). Int J Cardiol. 2006 Jul 28;111(1):147-53.[Abstract]
64. Szuba A, Wysokinski W, Czarnacki M, et al. Coexistence of Buerger's disease with atherosclerosis obliterans. In: 9th International symposium on atherosclerosis. 1991; abstract 178.