Summary
Definition
History and exam
Other diagnostic factors
- paresthesias/cold sensation/cyanosis in limb or finger
- ulceration/gangrene
- claudication
- rest pain
- superficial thrombophlebitis
- cold limb or finger
- pale limb or finger
- absence of distal pulses
- positive Allen test
- joint arthritis
- duration of joint symptoms up to 2 weeks
Risk factors
- smoking
- age <40 years
- region of origin: southeast Mediterranean, Middle East, and Far East
- male sex
- periodontal infection
- human leukocyte antigen (HLA) haplotypes
Diagnostic investigations
1st investigations to order
- blood glucose
- BUN
- serum creatinine
- complete blood count (CBC) with differential
- coagulation screen
- thrombophilia screen
- C-reactive protein (CRP)
- erythrocyte sedimentation rate (ESR)
- arterial Doppler
Investigations to consider
- antinuclear antibody
- rheumatoid factor
- antineutrophilic cytoplasmic antibody (ANCA)
- complement levels
- anticentromere antibody
- topoisomerase I antibodies (Scl-70)
- echocardiogram
- arterial duplex
- digital subtraction angiography
- anticardiolipin antibodies
Emerging tests
- CT angiography
- magnetic resonance angiography
- tissue biopsy
- genetic testing
Treatment algorithm
critical ischemia
noncritical ischemia
Contributors
Authors
Matthew J. Metcalfe, MD, FRCS, FEBVS, FHEA
Consultant Vascular Surgeon
Lister Hospital
East and North Hertfordshire NHS Trust
Hertfordshire
UK
Disclosures
MJM declares that he has no competing interests.
Alun H. Davies, MA, DM, FRCS, FHEA
Professor of Vascular Surgery and Honorary Consultant Surgeon
Department of Vascular Surgery
Faculty of Medicine
Imperial College of Medicine
Charing Cross Hospital
London
UK
Disclosures
AHD declares that he has no competing interests.
Peer reviewers
Kosmas I. Paraskevas, MD, FASA
Department of Vascular Surgery
Red Cross Hospital
Athens
Greece
Disclosures
KIP declares that he has no competing interests.
Maureen K. Sheehan, MD
Assistant Professor of Surgery
Division of Vascular Surgery
University of Texas Health Science Center at San Antonio
San Antonio
TX
Disclosures
MKS declares that she has no competing interests.
Peter F. Lawrence, MD
Chief of Vascular Surgery
Director
Gonda Vascular Center
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
PFL declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Embolic disease
- Hypercoagulable state
- Raynaud phenomenon (RP)
More DifferentialsPatient information
Raynaud phenomenon
Quitting smoking
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