Buerger's disease : A vascular disease in young smokers

Buerger's disease also known as thromboangiitis obliterans is a disease exclusively found in young men who are chronic smokers. It is an inflammatory condition of the arteries and involves mainly medium and small arteries. The incidence of Buerger's disease is seen more frequently in men under age 40. The disease is more prevalent among Asians and individuals of eastern European descent.

What is Buerger's disease

Buerger's disease or thromboangiitis obliterans is a disease in which there is occlusion of small and medium arteries mainly plantaris, tibial ans radial arteries. There is also inflammation of the veins which may in suferficial as well as deep veins. Raynaud's phenomenon may be seen which can be described as an abnormal sensitivity in the direct response of the cold.

Raynaud's phenomenon

On exposure to cold the small blood vessels constricts and as a result the part supplied by these vessels becomes blanched and incapable of finer movements and gradually the capillaries dilate and get filled with blood giving a dusky and swollen appearance.

Raynaud's phenomenon is typically seen in females but when it appears in male and that too in young one below 40, it is certainly due to Buerger's disease.

Risk factors for Buerger,s disease

Buerger's disease is of unknown etiology but there are certain risk factors or predisposing factors for its cause. These are

Smoking

Smoking is the most common risk factors and now a days the incidence is increasing even when nictine is being taken in other forms like chewing tobacco or nicotine patch, but still it is only smoking which hold the major risk.

Age, Sex and Race

Buerger's disease is a disease of young men, thus a person above 40 years having features of claudication or raynaud's phenomenon in certainly not due to Buerger's disease. Men is the most commonly affected. Earlier it was an exclusive disease of men but as the incidence of smoking has increased in women, the incidence in women is now a days increasing.

Natives of India, Korea, and Japan, and Israeli Jews of Ashkenazi descent (Eastern Europe), have the highest incidence of the disease and less incidence is seen in USA and Northern Europe.

Genetic factor

Buerger's disease is also genetically linked and a person having HLA-A9, HLA-A54, and HLA-B5 are more prone in developing the disease.

Causes of Buerger's disease

The cause of Buerger's disease is unknown but smoking holds the key. The vessels particularly the arteries get swollen due to rush of blood preceded by a contriction due to cold exposure. The arteries specially the smaller arteries is occluded and there the muscles gets necrosed due to ischemia causing ischemic ulcers which is very difficult to heal and sometimes may even lead to amputation of the limb.

Diagnosis of the Buerger's disease depend upon the classical features and history of the predisposing factors with some investigations like arteriography. Details of sign and symptoms and diagnosis can be seen at Diagnosis of Buerger's disease.

It is a disease difficult to treat and absotute abstinence from alcohol is necessary. Patient may get much help by normal arterial surgery and sometimes sympathectomy may require. In severe cases amputation of the limb may be required to save the patient. Thus one should be extremely conscious. Though now a days prostaglandins has been effective in arresting the disease. Though prevention is the bestmeasure to save the limb and to protect from disbility, morbidity and mortality. For detail treatment see at Treatment and Prevention of Buerger's disease.