Thromboangiitis obliterans (Buerger disease)
Thromboangiitis obliterans (Buerger disease) is a segmental, nonatherosclerotic inflammatory thrombosis of small and medium arteries and veins in the distal extremities, seen almost exclusively in tobacco users under 40 years old. Diagnosis is by exclusion: normal proximal vessels, a normal cardioembolic and autoimmune workup, and angiography showing abrupt distal occlusions with corkscrew collaterals. First-line and only disease-modifying treatment is complete tobacco cessation; revascularization is rarely possible in this distal, diffuse disease.
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What this article covers
- Overview
Definition: a segmental, nonatherosclerotic inflammatory thrombosis of small and medium arteries and veins in the distal extremities.
- Epidemiology
Age and sex: onset is typically in the second to fourth decade, usually under 40 and often under 30; historically male-predominant, though the incidence in women has increased in recent decades.
- Risk factors
Tobacco use: a hallmark of the disease is addiction to tobacco; essentially all patients are current smokers or heavy users at diagnosis.
- Pathophysiology
Segmental thrombosing inflammation of small and medium vessels: a segmental thrombosing vasculitis with vein and nerve involvement, affecting distal arteries initially and primarily rather than starting proximally.
- Clinical features
Foot claudication: nearly universal, typically of the arch or calf, and often the presenting symptom.
- Differential diagnosis
Premature atherosclerosis / peripheral artery disease: the closest mimic; claudication and diminished pulses, but in an older population (rarely before the fifth decade), with proximal, calcified…
- Diagnosis
The diagnosis is established by a set of clinical criteria, not a single confirmatory test: age under 40 (often under 30), male sex most often, tobacco or cannabis use, superficial phlebitis with…
- Management
First-line and the only disease-modifying step is complete tobacco cessation, counseling plus pharmacotherapy; it ameliorates the disease course and lowers ulcer and amputation risk, and nothing…
- Complications
Digital ulceration and gangrene: the direct consequence of untreated distal ischemia and the proximate cause of most amputations.
- Prognosis
Cessation is the determinant of course: smoking cessation ameliorates the course and lowers ulcer and amputation risk; continued use predicts progression to ulceration, gangrene, and amputation.
- Prevention
Complete, sustained tobacco and cannabis cessation is the only preventive measure that changes the disease's course; any continued use, including secondhand exposure or switching products, lets disease activity continue.
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