Buerger Disease

What is buerger disease?

Buerger disease, also called thromboangiitis obliterans, is a rare condition in which the small and medium-sized blood vessels of the arms and legs become inflamed and blocked. The name thromboangiitis obliterans describes what happens inside the body: “thrombo” refers to blood clots, “angiitis” means inflammation of blood vessels, and “obliterans” means that the vessels become narrowed or closed off. When these vessels are blocked, blood cannot flow properly to the hands, feet, fingers, and toes. Without enough blood, the tissues in these areas do not receive the oxygen and nutrients they need, which causes pain and, in severe cases, tissue damage.

Many people searching for “what is buerger disease” want to know how it differs from other circulation problems. Unlike atherosclerosis (the buildup of fatty deposits inside arteries, which usually affects older adults), buerger disease involves inflammation and clotting in otherwise relatively healthy vessels, and it typically appears in younger people. The condition is coded as I73.1 in the ICD-10 classification system used by doctors worldwide.

Buerger disease most often affects men younger than 45 years of age, although women can also develop it, and the number of affected women appears to be rising in some regions. The single most important fact about this condition is its very strong link to tobacco use. Nearly everyone diagnosed with buerger disease is a current or recent user of tobacco in some form, including cigarettes, cigars, chewing tobacco, and, in some reports, heavy exposure to secondhand smoke. The disease is more commonly reported in parts of the Middle East, Asia, and Eastern Europe, which may partly reflect patterns of tobacco use in those regions.

Symptoms of buerger disease

Buerger disease symptoms usually begin in the hands and feet and may later move upward toward the arms and legs. Because the condition affects the smaller vessels farthest from the heart, the fingers and toes are often the first areas to be affected. Common buerger disease symptoms include:

• Pain in the hands, feet, fingers, or toes — often a burning or tingling pain that may occur at rest, not only during activity.
• Claudication — cramping pain in the feet, calves, or arms that appears during exercise (such as walking) and eases with rest. Pain in the arch of the foot during walking is a classic early sign.
• Cold, pale, or bluish fingers and toes — the affected areas may feel cold to the touch and change color, especially in cold weather.
• Raynaud phenomenon — episodes in which fingers or toes turn white, then blue, and then red in response to cold or stress, often with numbness or tingling.
• Numbness and tingling in the hands or feet.
• Painful open sores (ulcers) on the fingers or toes that heal slowly or not at all.
• Inflamed veins near the surface of the skin — a condition called superficial thrombophlebitis, which appears as tender, red cords or lumps along a vein.
• Gangrene — in advanced disease, tissue in a finger or toe may die because of a complete loss of blood supply. Gangrenous tissue often looks black or dark and may have a foul smell. This is a medical emergency.

Symptoms often differ depending on the stage of the disease. In the early stage, many people notice only intermittent symptoms: cold sensitivity, tingling, or cramping pain during activity. At this point the vessels are inflamed but blood flow may still be partly preserved. As the disease progresses, pain may occur even at rest, particularly at night, and often improves temporarily when the person hangs the affected limb over the side of the bed (gravity helps blood reach the foot or hand). In the late stage, ulcers and gangrene can develop, usually starting at the tips of the fingers or toes. Symptoms frequently affect more than one limb, and it is common for both legs or both hands to be involved, even if one side is worse than the other.

Because the early signs can be subtle and easily mistaken for other problems, people with buerger disease sometimes go months before the condition is recognized. Anyone who uses tobacco and develops persistent pain, color changes, or sores in the fingers or toes should discuss these symptoms with a doctor promptly.

Causes and risk factors

The exact cause of buerger disease is not fully understood, but the connection with tobacco is overwhelming and central to everything doctors know about this condition. When people ask about buerger disease causes, the honest answer is that tobacco exposure appears to trigger the disease in people who are susceptible to it, although researchers do not yet know exactly why some tobacco users develop it and most do not.

Several mechanisms are thought to play a role:

• Immune reaction to tobacco components. Many researchers believe that substances in tobacco provoke an abnormal immune response that attacks the lining of small and medium blood vessels, causing inflammation and clot formation.
• Genetic susceptibility. The disease is more common in certain populations, which suggests that inherited factors may make some people more vulnerable.
• Damage to the vessel lining. Inflammation appears to injure the inner layer of the vessel wall, encouraging blood clots to form and block the vessel while the wall itself remains relatively intact — a feature that helps distinguish buerger disease from other forms of vasculitis (blood vessel inflammation).

Recognized risk factors include:

• Tobacco use of any kind — cigarettes, cigars, pipes, chewing tobacco, and snuff have all been linked to the disease. Heavy smokers appear to be at the highest risk, but even light or occasional use can be enough to trigger or worsen the condition in susceptible people.
• Male sex — most diagnosed patients are men, though this gap may partly reflect historical differences in smoking rates.
• Age under 45 — the disease typically begins in young adulthood, which sets it apart from atherosclerosis.
• Regional and ethnic background — higher rates are reported in the Middle East, South and East Asia, and Eastern Europe.
• Chronic gum disease — some studies have observed an association between long-standing gum infections and buerger disease, although the meaning of this link is still being studied.

It is important to understand that buerger disease is not caused by high cholesterol, high blood pressure, or diabetes in the way that ordinary artery disease often is. In fact, doctors usually rule out those conditions as part of making the diagnosis.

Diagnosis

There is no single laboratory test that can confirm buerger disease. Instead, buerger disease diagnosis relies on a combination of the patient’s history, a physical examination, imaging studies, and tests that exclude other conditions that can look similar. Doctors often use published clinical criteria — such as age under about 45 to 50, current or recent tobacco use, evidence of poor blood flow in the limbs, typical imaging findings, and the exclusion of other causes — to support the diagnosis.

Steps and tests your doctor may use include:

• Medical history and physical examination. The doctor will ask in detail about tobacco use, the pattern of pain, and any sores or color changes. On examination, they check the pulses in the wrists, ankles, and feet; weak or absent pulses in the affected limbs are common in buerger disease.
• Allen test. This is a simple bedside test of blood flow in the hand. The doctor presses on the two arteries at the wrist while the patient clenches the fist, then releases one artery at a time to see how quickly color returns to the hand. Slow return of color suggests blocked arteries in the hand, which is a typical finding.
• Ankle-brachial index (ABI). This test compares blood pressure at the ankle with blood pressure in the arm to measure how well blood is reaching the legs.
• Doppler ultrasound. A painless scan that uses sound waves to show how blood is flowing through the arteries of the arms and legs.
• Angiography. This is imaging of the blood vessels, performed either with a catheter and contrast dye (conventional angiography) or with CT or MRI scanning. In buerger disease, angiography often shows segmental blockages of the small and medium arteries of the hands and feet, with characteristic small, twisting “corkscrew” vessels that form around the blockages as the body tries to reroute blood flow.
• Blood tests. These are used mainly to rule out other conditions, such as autoimmune diseases (for example lupus or scleroderma), clotting disorders, and diabetes. In buerger disease, the usual markers of autoimmune disease are typically normal or negative.
• Echocardiography. An ultrasound of the heart may be performed to make sure that blood clots traveling from the heart are not the true cause of the blockages.

Because the treatment and outlook depend so heavily on getting the diagnosis right, doctors take care to exclude atherosclerosis, autoimmune vasculitis, clotting disorders, and sources of traveling clots before concluding that a patient has buerger disease. A biopsy (taking a small sample of a vessel for examination under a microscope) is rarely needed but may occasionally be done when the picture is unclear.

Treatment options for buerger disease

The foundation of buerger disease treatment is complete and permanent avoidance of tobacco and nicotine in all forms. This point cannot be overstated: no medication or operation works as well as stopping tobacco entirely. In many cases, people who quit completely see the disease stop progressing, and their risk of amputation falls dramatically. People who continue to use tobacco — even small amounts, and even smokeless products — typically continue to worsen. Some doctors advise caution even with nicotine replacement products (patches or gum), because nicotine itself may keep the disease active; your doctor can recommend the safest way for you to quit, which may include non-nicotine medications and counseling support.

Beyond quitting tobacco, treatment focuses on improving blood flow, relieving pain, protecting the limbs, and healing any sores. Options your doctor may consider include:

• Medications to improve blood flow. Drugs called vasodilators, which widen blood vessels, may be prescribed. Prostacyclin analogues (medicines given by vein that relax vessels and reduce clotting, such as iloprost) are sometimes used for severe pain at rest or for ulcers, particularly when surgery is not possible. Calcium channel blockers may help when Raynaud-type color changes are prominent.
• Pain management. Ischemic pain (pain from poor blood supply) can be severe. Doctors may use a stepwise approach to pain relief while working to improve circulation.
• Wound care. Ulcers on the fingers and toes need careful cleaning, dressing, and protection to prevent infection. Antibiotics are used if a sore becomes infected.
• Foot and hand protection. Because even minor injuries can turn into non-healing sores, patients are advised to protect their hands and feet from cold, cuts, pressure, and poorly fitting shoes.
• Supervised exercise. Walking programs may help build up small alternative blood-flow channels (collateral circulation) in some patients, when this is safe to do.
• Spinal cord stimulation and sympathectomy. In selected patients with severe pain, doctors may consider a spinal cord stimulator (an implanted device that alters pain signals) or a sympathectomy (a procedure that interrupts certain nerves to help vessels relax). Results vary from person to person, and these are not routine treatments.
• Revascularization surgery. Bypass surgery — creating a new route for blood around a blocked artery — is possible only in a minority of patients, because buerger disease usually blocks the small vessels of the hands and feet, where there is often no healthy vessel below the blockage to connect to. When suitable target vessels exist, a vascular team may attempt bypass to save a threatened limb. Evaluation and surgical care for these situations are typically provided by a specialized vascular team; at Acibadem hospitals, for example, this falls under the Cardiovascular Surgery department.
• Amputation. When gangrene develops or infection cannot be controlled, removing the dead part of a finger, toe, or limb may be necessary to protect the patient’s life and relieve unmanageable pain. Amputation is far more common in patients who keep using tobacco than in those who quit.

Some experimental approaches, such as therapies aimed at stimulating new blood vessel growth, have been studied, but they are not yet standard care. Your doctor can explain whether any clinical trials are relevant to your situation.

Watchful waiting alone — that is, monitoring without any action — is generally not appropriate for buerger disease, because the single decisive action, stopping tobacco, is always indicated. However, in patients who have quit and whose symptoms are mild and stable, treatment may consist mainly of regular follow-up, limb protection, and prompt attention to any new sores.

Living with buerger disease and outlook

The long-term outlook in buerger disease depends more on tobacco than on any other single factor. For people who stop all tobacco and nicotine exposure, the disease often becomes inactive: pain frequently improves, ulcers have a better chance of healing, and the risk of losing a finger, toe, or limb drops substantially. For those who continue any form of tobacco use, the disease usually keeps progressing, and repeated ulcers, worsening pain, and amputations become much more likely over time. Buerger disease itself rarely shortens life, but it can seriously affect quality of life, work, and independence when limbs are damaged.

Practical steps that many doctors recommend for daily life include:

• Avoiding all tobacco, nicotine, and, where possible, secondhand smoke.
• Keeping the hands and feet warm, especially in cold weather, since cold narrows blood vessels further.
• Inspecting the feet and hands daily for cuts, blisters, or color changes, and treating even small injuries carefully.
• Wearing well-fitting, protective footwear and avoiding walking barefoot.
• Attending regular follow-up visits so that any new blockage or sore is caught early.
• Maintaining good dental and gum care, given the possible association between gum disease and buerger disease.
• Seeking support for quitting tobacco — counseling, support groups, and doctor-prescribed quit aids all improve the chances of success, and quitting is often difficult without help.

It is honest to say that buerger disease has no guaranteed cure. But it is equally honest to say that, in many cases, patients who quit tobacco completely can live full, active lives with the disease held in check. Ongoing care is usually shared between vascular specialists and the patient’s primary doctor.

Frequently asked questions

What is buerger disease in simple terms?

Buerger disease is a condition in which the small and medium blood vessels of the arms and legs become inflamed and blocked by clots, usually in young or middle-aged people who use tobacco. Because blood cannot reach the hands and feet properly, patients develop pain, color changes, and sometimes sores on the fingers and toes. Its medical name is thromboangiitis obliterans.

Can buerger disease be cured or heal on its own?

There is currently no medication or operation that cures buerger disease outright, and it does not simply heal on its own while tobacco exposure continues. However, in many people the disease becomes inactive after they stop all tobacco and nicotine completely, and symptoms may improve considerably over time. Ongoing follow-up is still important, because existing vessel damage does not fully reverse.

How serious is buerger disease?

Buerger disease can be very serious for the limbs, even though it rarely threatens life directly. If it progresses, it can cause severe pain, non-healing sores, and gangrene, which may lead to amputation of fingers, toes, or parts of a limb. The seriousness in an individual case depends heavily on how early the disease is recognized and, above all, on whether the person stops using tobacco.

What are the first buerger disease symptoms people usually notice?

Early symptoms often include cold, tingling, or numb fingers and toes, cramping pain in the feet or calves during walking that eases with rest, and color changes in the fingers when exposed to cold. Some people first notice tender, cord-like inflamed veins under the skin. Because these signs can be mild at first, they are easy to overlook, especially in young people who do not expect circulation problems.

What causes buerger disease if I don’t have high cholesterol?

Buerger disease is not caused by cholesterol buildup. It is strongly linked to tobacco use, which appears to trigger inflammation and clotting in the blood vessels of susceptible people. Doctors believe an abnormal immune reaction to tobacco components plays a central role, possibly combined with genetic factors, but the exact mechanism is still not fully understood.

How do doctors confirm a buerger disease diagnosis?

There is no single confirmatory test. Doctors combine the patient’s age, tobacco history, and symptoms with examination findings, blood-flow tests such as Doppler ultrasound and the ankle-brachial index, and angiography, which often shows characteristic blockages with small corkscrew-shaped vessels. Blood tests and sometimes a heart ultrasound are used to rule out other conditions, such as autoimmune diseases or clots traveling from the heart, before the diagnosis is made.

What happens if I quit smoking after being diagnosed?

Quitting completely is the most effective known treatment. In many cases, the disease stops progressing after all tobacco and nicotine exposure ends, pain improves, and the risk of amputation falls sharply. The benefit depends on stopping entirely — even occasional smoking or smokeless tobacco can keep the disease active. Your doctor can help you choose quit-support methods that are appropriate for buerger disease.

When to see a doctor

Anyone who uses tobacco and develops persistent pain, numbness, or color changes in the hands or feet should be evaluated by a doctor, because early recognition of buerger disease gives the best chance of protecting the limbs. If you have already been diagnosed, keep your scheduled follow-up visits even when you feel well.

Seek medical attention urgently — the same day, or through emergency services if needed — if you notice any of the following red-flag signs:

• A finger, toe, foot, or hand that turns black, dark blue, or gray, which may indicate dying tissue (gangrene).
• Sudden severe pain, coldness, paleness, or loss of feeling in a limb, which can signal a sudden complete blockage of blood flow.
• An open sore or wound on a finger or toe that is not healing, is spreading, or is becoming more painful.
• Signs of infection around a sore, such as increasing redness, swelling, warmth, pus, foul odor, or fever.
• Rest pain that keeps you awake at night or forces you to hang your leg out of bed for relief, especially if it is new or worsening.
• A tender, red, cord-like vein appearing under the skin of an arm or leg.

These warning signs suggest that blood flow to a limb may be critically reduced, and prompt treatment can make the difference between saving and losing a finger, toe, or limb. Even if you are unsure whether a symptom is serious, it is safer to have it checked than to wait.