Buerger disease is a nonatherosclerotic 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 East origin who smoke.
Presents as an acutely ischemic 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. Histologic analysis of arterial specimens shows preservation of the internal elastic lamina.
Best outcomes are associated with smoking cessation.
Life expectancy is not altered.
Buerger disease is a nonatherosclerotic 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
Other diagnostic factors
- paresthesias/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
- 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)
- arterial duplex
- digital subtraction angiography
- anticardiolipin antibodies
- CT angiography
- magnetic resonance angiography
- tissue biopsy
- genetic testing
Matthew J. Metcalfe, MD, FRCS, FEBVS, FHEA
Consultant Vascular Surgeon
East and North Hertfordshire NHS Trust
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
AHD declares that he has no competing interests.
Kosmas I. Paraskevas, MD, FASA
Department of Vascular Surgery
Red Cross Hospital
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
MKS declares that she has no competing interests.
Peter F. Lawrence, MD
Chief of Vascular Surgery
Gonda Vascular Center
David Geffen School of Medicine at UCLA
PFL declares that he has no competing interests.
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