Buerger’s disease – causes, first symptoms and treatment

Proven content

Buerger’s disease is a thromboembolic inflammation of the peripheral arteries and veins that produces symptoms and effects that are identical to those of peripheral arteriosclerosis of the lower extremities. Subjectively felt and observed symptoms are almost identical to those in peripheral limb atherosclerosis. Buerger’s disease, unlike atherosclerosis, appears much earlier, at a young age.

What is Buerger’s disease and what are its causes?

Buerger’s disease is an inflammation of the vessels of a thrombotic-obliterating nature. In its essence, however, it is a disease entity that differs from atherosclerosis, because its development is caused by inflammatory and proliferative changes in the endothelium of the vessels, which are accompanied by an inflammatory-thrombotic process that gradually attacks the veins outside the arteries. The obvious effect of this type of changes is the progressive narrowing of the vessel lumen and, consequently, impaired blood flow and tissue hypoxia. The ailment usually occurs in smokers. Treatment is based on the use of pharmacological agents and surgical methods.

The cause of Buerger’s disease is unknown, but there are certain factors that increase your risk of developing this condition:

1. genetic factors,
2. inflammatory factors,
3. autoimmune factors,
4. smoking (referred to as the main cause of the disease)
5. men at an early age.

Buerger’s disease – symptoms

The most characteristic symptom of Buerger’s disease is pain where the blood is not circulating properly. Disease symptoms are usually felt by the patient in the lower limbs. In addition, the patient feels cold and cyanosis appears. Additionally, there may be paraesthesia (tingling, tingling, numbness) and pain in the calves and feet that increase with walking. Pain ailments are paroxysmal, and in advanced cases of the disease, ulcerations appear most often on the fingers or toes, i.e. places where there were wounds and abrasions of the epidermis.

Other symptoms that occur in the course of the disease are:

1. blood clots in the lumen of blood vessels – they can block the lumen of arteries and veins, and consequently limb ischemia,
2. gradually turning pale, bruising and reddening of further parts of the feet and hands due to exposure to cold,
3. areas of necrosis formed on the fingers of the limbs (along with the advancement of the changes).

Buerger’s disease, which lasts for several years, leads to periods of exacerbation and remission, accompanied by inflammation of the superficial veins, and even in some patients depression resulting from bothersome symptoms.

Buerger’s disease – diagnosis

The basis of diagnostics is a thorough medical interview with the patient and a series of additional tests. During the diagnosis, the physician should take into account whether the patient smokes cigarettes and check whether the patient has nicotine discoloration on the nails and fingers.

The following tests are helpful in the diagnosis of Buerger’s disease:

1. a test of the level of carbon monoxide hemoglobin in the blood (its high concentration means that the patient has been exposed to tobacco smoke for a long time),
2. Allen’s test – helps to determine whether the disease has attacked the arteries of the upper extremities. It consists in pressing the elbow and radial arteries by the doctor while lifting the patient’s hand upwards. As soon as the hand turns pale, the pressure is released, and then the time to return to normal circulation is assessed. If the hand remains pale for more than fourteen seconds, the patient has abnormal arterial vascularization in that area.
3. arteriography – allows you to reveal the obstruction of the vessels, even before the first symptoms of the disease appear,
4. blood pressure measurement using ultrasound,
5. histopathological examination of the collected vein section.

In addition to performing diagnostic tests, Buerger’s disease should be differentiated from other ailments with similar symptoms, e.g .:

1. atherosclerosis,
2. systemic connective tissue disease, e.g. SLE,
3. Raynaud’s disease (there are also vasomotor disorders),
4. arterial compression syndrome, such as upper thoracic outlet syndrome or muscle slanting syndrome

Treatment of Buerger’s disease

Before any treatment is undertaken, patients should be made aware that there are factors that may be causing it. Patients should be advised to quit smoking.

The accompanying pain can be relieved with non-steroidal anti-inflammatory drugs or (in severe cases) with opioids or epidural anesthesia. Taking into account the fact that Buerger’s disease is caused by excessive aggregation of thrombocytes and is characterized by the formation of blood clots closing the lumen of blood vessels, anticoagulant and antiplatelet preparations are used in the form of:

1. unfractionated or low molecular weight heparin;
2. acetylsalicylic acid (75-100 mg daily);
3. prostanoids and pentoxifylline.

Treatment of ulcers that appear in Buerger’s disease is based on the use of saline or hydrogel dressings. In some patients it is necessary to separate the necrosis by mechanical means. If an infection occurs in the area of ​​necrosis – antibiotics are administered.

How can I prevent Buerger’s disease?

The preventive management of Buerger’s disease includes:

1. avoid wearing damp, too tight and wind-free shoes,
2. avoid excessive cooling of the limbs,
3. avoid factors that increase the risk of atherosclerosis,
4. quit smoking cigarettes,
5. avoid stress,
6. avoid excessive walking and standing, and thus fatigue of the limbs,
7. take care of a low-fat diet.