Buerger's Disease
Inflammation and clotting of small limb vessels linked to tobacco
Quick Facts
- Type: Vascular (blood vessel) disease
- Affects: Small/medium vessels of hands and feet
- Strongest link: Tobacco use
- Key treatment: Complete tobacco cessation
Overview
Buerger's disease, also called thromboangiitis obliterans, is a rare condition in which the small and medium-sized arteries and veins of the arms and legs become inflamed and develop clots. This narrows or blocks the vessels, reducing blood flow to the hands, feet, fingers, and toes. The reduced circulation causes pain and, in advanced cases, can lead to skin sores and tissue death.
The disease is very strongly linked to tobacco use, including cigarettes, cigars, and chewing tobacco. It most often affects younger adults who smoke. There is no cure, but the single most important and effective treatment is completely stopping all tobacco use, which can halt the disease and prevent the loss of fingers, toes, or limbs.
Symptoms
Symptoms usually begin in the hands and feet and result from poor blood flow.
- Pain in the hands and feet, sometimes coming and going, that may worsen with activity or at rest in advanced disease
- Cramping in the legs, feet, arms, or hands during use that eases with rest (claudication)
- Fingers and toes that turn pale, red, or bluish, or feel cold
- Fingers or toes that change color in the cold (Raynaud-like response)
- Painful open sores on the fingers or toes
- In severe cases, tissue death (gangrene) of the fingers or toes
Painful, non-healing sores or blackened skin on the fingers or toes are signs of severe disease and need urgent medical attention.
Causes
The exact cause is not fully understood, but tobacco plays a central role.
- Tobacco use: Nearly all people with Buerger's disease use or have used tobacco. Chemicals in tobacco are thought to trigger or worsen the inflammation of the blood vessels.
- Immune response: The body's immune system appears to react against the lining of the blood vessels, causing inflammation and clotting.
The combination of inflammation and clot formation progressively narrows and blocks the vessels, cutting off circulation to the affected limbs.
Risk Factors
- Any use of tobacco, including smoking and chewing
- Being a young to middle-aged adult
- Heavy or long-term tobacco use
- A history of chronic gum disease has been noted in some people, though tobacco remains the dominant factor
Diagnosis
There is no single test for Buerger's disease, so doctors rely on the pattern of symptoms and on excluding other causes of poor circulation.
- History and examination: A young smoker with limb pain and finger or toe involvement raises suspicion.
- Blood tests: To rule out diabetes, clotting disorders, and other vascular diseases.
- Angiography: Imaging of the blood vessels that can show the characteristic pattern of blockages in small vessels.
- The Allen test: A simple bedside test of blood flow to the hand.
Treatment
The cornerstone of treatment is the complete and permanent stopping of all tobacco use.
- Tobacco cessation: Quitting all tobacco, including nicotine products, is the only proven way to stop the disease from progressing and to avoid amputation.
- Medications: Drugs to widen blood vessels, improve blood flow, and manage pain may help symptoms.
- Wound care: Careful care of any sores to promote healing and prevent infection.
- Procedures: In some cases, treatments to improve circulation are tried, though their benefit is limited.
- Amputation: A last resort for severe tissue death or infection that cannot be controlled.
Even small amounts of continued tobacco use can keep the disease active, so total cessation is essential.
Prevention
- Do not use any form of tobacco; if you do, stop completely and seek support to quit
- Avoid nicotine replacement long-term if you have the disease, as advised by your doctor
- Protect your hands and feet from cold and injury
- Inspect fingers and toes regularly for sores or color changes
- Care for any wounds promptly to prevent infection
When to See a Doctor
See a doctor if you use tobacco and develop pain, color changes, or coldness in your hands or feet, or sores that are slow to heal. Seek urgent care for painful, non-healing ulcers, blackened skin, or signs of infection such as spreading redness, fever, or worsening pain, since these indicate advanced disease that can threaten the fingers, toes, or limb. The most important step you can take is to stop all tobacco use immediately.
Frequently Asked Questions
What is Buerger's disease?
It is a rare condition in which small and medium arteries and veins of the arms and legs become inflamed and clotted, reducing blood flow to the hands and feet. It causes pain, color changes, and, in severe cases, sores and tissue death.
What causes Buerger's disease?
Its exact cause is unclear, but it is very strongly linked to tobacco use. Nearly everyone with the disease uses or has used tobacco, and the chemicals appear to trigger inflammation of the blood vessels.
Can Buerger's disease be cured?
There is no cure, but the disease can be stopped from progressing by completely quitting all tobacco. Total tobacco cessation is the single most effective treatment and the best way to avoid losing fingers, toes, or limbs.
Why is quitting tobacco so important?
Even small amounts of continued tobacco use keep the inflammation active and the disease progressing. Stopping all tobacco, including nicotine products, is the only proven way to halt damage and prevent amputation.
When is Buerger's disease an emergency?
Seek urgent care for painful, non-healing sores, blackened skin on fingers or toes, or signs of infection such as spreading redness, fever, or worsening pain. These point to advanced disease that can threaten the limb.
References
- Mayo Clinic. Buerger's disease — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Thromboangiitis obliterans.
- National Organization for Rare Disorders (NORD). Buerger's Disease.
- Vascular Cures / Society for Vascular Surgery. Buerger's disease.