Buerger's disease is a non-atherosclerotic 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 Eastern origin who smoke.
Presents as an acutely ischaemic 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. Histological analysis of arterial specimens shows preservation of the internal elastic lamina.
Best outcomes are associated with smoking cessation.
Life expectancy is not altered.
Buerger's disease is a non-atherosclerotic vasculitis resulting in segmental occlusions of small and medium-sized arteries, commonly affecting the lower limbs of young men who smoke. A hypercellular thrombus fills the lumen. Patients usually present with rest pain or tissue loss, and rarely present with claudication. Also known as thromboangiitis obliterans.
History and exam
Key diagnostic factors
- presence of risk factors
Other diagnostic factors
- paraesthesias/cold sensation/cyanosis in limb or finger
- 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
- age <40 years
- region of origin: southeast Mediterranean, Middle East, and Far East
- male sex
- periodontal infection
- human leukocyte antigen (HLA) haplotypes
1st investigations to order
- blood glucose
- serum creatinine
- full blood count (FBC) with differential
- coagulation screen
- thrombophilia screen
- C-reactive protein (CRP)
- erythrocyte sedimentation rate (ESR)
- arterial Doppler
Investigations to consider
- anti-nuclear antibody
- rheumatoid factor
- anti-neutrophilic cytoplasmic antibody (ANCA)
- complement levels
- anti-centromere antibody
- topoisomerase I antibodies (Scl-70)
- arterial duplex
- digital subtraction angiography
- anti-cardiolipin antibodies
- CT angiography
- magnetic resonance angiography
- tissue biopsy
- genetic testing
- Embolic disease
- Hypercoagulable state
- Raynaud's phenomenon (RP)
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