The true story of my life.I have Buerger's Disease. Cigarettes didn't do this to me. I did it myself. Smoking Got Me. I lost.

Buerger's Disease

What is Buerger's Disease

Buerger's disease thromboangiitis obliterans is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease, your blood vessels swell and can become blocked with blood clots (thrombi). This eventually damages or destroys skin tissues and may lead to infection and gangrene. Buerger's disease usually first shows in the hands and feet and may expand to affect larger areas of your arms and legs.

Buerger's Disease : Brandon Carmichael

Buerger's disease is rare in the United States, but is more common in the Middle East and Far East. Buerger's disease usually affects men between ages 20 and 40, though it's becoming more common in women.

Virtually everyone diagnosed with Buerger's disease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop Buerger's disease. For those who don't quit, amputation of all or part of a limb may ultimately be necessary


Symptoms of Buerger's Disease

Buerger's Disease : Brandon Carmichael

Buerger's disease symptoms include:

  • Pain and weakness in your legs and feet or your arms and hands
  • Swelling in your feet and hands
  • Fingers and toes that turn pale when exposed to cold (Raynaud's phenomenon)
  • Open sores on your fingers and toes
When to see a doctor

See your doctor if you think you may have signs or symptoms of Buerger's disease.


Causes

It isn't clear what triggers Buerger's disease. The condition is caused by swelling in the arteries and veins of the arms and legs. The cells that cause the swelling, and eventually blood clots, form in the vessels leading to your hands and feet and block the blood flow to those parts of your body.

Reduced blood flow means that the skin tissue in your hands and feet doesn't get adequate oxygen and nutrients. This leads to the signs and symptoms of Buerger's disease, beginning with pain and weakness in your fingers and toes and spreading to other parts of your arms and legs.


Risk Factors

Tobacco use Cigarette smoking greatly increases your risk of Buerger's disease. Heavy cigarette smokers (people who smoke one and a half packs a day or more) are most likely to develop Buerger's disease, though it can occur in people who use any form of tobacco, including cigars and chewing tobacco. People who smoke hand-rolled cigarettes using raw tobacco may have the greatest risk of Buerger's disease.

It isn't clear how tobacco use increases your risk of Buerger's disease, but virtually everyone diagnosed with Buerger's disease uses tobacco. It's thought that chemicals in tobacco may irritate the lining of your blood vessels, causing them to swell. Rates of Buerger's disease are highest in areas of the Middle East and Far East where heavy smoking is most common.

Although secondhand smoke isn't thought to be a major risk factor for Buerger's disease, if you're diagnosed, you should stay away from people who are smoking. Secondhand smoke could worsen your condition.


Complications

If Buerger's disease worsens, blood flow to your arms and legs decreases. This is due to blockages that make it hard for blood to reach the tips of your fingers and toes. Tissues that don't receive blood don't get the oxygen and nutrients they need to survive. This can cause the skin and tissue on the ends of your fingers and toes to die (gangrene). Signs and symptoms of gangrene include black or blue skin, a loss of feeling in the affected finger or toe and a foul smell from the affected area. Gangrene is a serious condition that usually requires amputation of the affected finger or toe.


Tests and Diagnosis

Your doctor will ask you about your signs and symptoms. No tests can confirm whether you have Buerger's disease. Instead, your doctor will likely order tests to rule out other more common conditions. These tests may include:

Blood tests

Blood tests to look for certain substances can rule out other conditions that may cause similar signs and symptoms. For instance, blood tests can help rule out scleroderma, lupus, blood clotting disorders and diabetes, along with other diseases and conditions.

The Allen's test

Your doctor may conduct a simple test called the Allen's test to check blood flow through the arteries carrying blood to your hands. In the Allen's test, you make a tight fist, which forces the blood out of your hand. Your doctor presses on the arteries at each side of your wrist to slow the flow of blood back into your hand, making your hand lose its normal color. Next, you open your hand and your doctor releases the pressure on one artery then the other. How quickly the color returns to your hand may give a general indication about the health of your arteries. Slow blood flow into your hand may indicate a problem, such as Buerger's disease.

Angiogram

An angiogram, also called an arteriogram, helps doctors see the condition of your arteries. Doctors inject dye into an artery and then take X-rays or other types of images. Images show any blockages in the artery. Your doctor may order arteriograms be performed on both of your arms and your legs, even if you don't have signs and symptoms of Buerger's disease in all of your limbs. Buerger's disease almost always affects more than one limb, so even though you may not have signs and symptoms in your other limbs, this test may detect early signs of vessel damage.


Treatments and Drugs

No treatments can cure Buerger's disease. Instead, your doctor may try various treatment approaches to reduce any signs and symptoms you have. Options include:

  • Counseling or medications to help you stop smoking and stop the swelling in your blood vessels
  • Medications to improve blood flow or to dissolve blood clots
  • Surgery to cut the nerves in the affected area (surgical sympathectomy) to control pain
  • Amputation, if infection or gangrene occurs

Lifestyle and home remedies

Take care of your fingers and toes if you have Buerger's disease. Check the skin on your arms and legs daily for cuts and scrapes, keeping in mind that if you've lost feeling to a finger or toe, you may not have felt, for example, a cut when it happened.

Low blood flow to your extremities means your body can't resist infection as easily. Small cuts and scrapes can easily turn into serious infections. Clean any cuts with water and cover them with a clean bandage. Keep an eye on any cuts or scrapes to make sure they're healing. If they get worse or heal slowly, see your doctor promptly.


Prevention

Quit using tobacco in any form

If you're diagnosed with Buerger's disease, you must stop using tobacco in order to stop the disease from getting worse. The swelling of your arteries stops when you quit using tobacco. Most people who quit tobacco won't have to face amputation of their fingers or toes in the future. Those who continue to use tobacco may worsen their Buerger's disease and need to have their affected fingers or toes removed.

It's hard to quit smoking. If you're like the majority of people who smoke, you've probably tried to quit in the past, but haven't been successful. Talk to your doctor about strategies to help you quit. Medications are available to ease your cravings. However, you won't be able to use nicotine replacement products, such as patches or gum, since the nicotine in these products also affects Buerger's disease.

Because it's crucial that you stop all tobacco use, your doctor may recommend more-aggressive approaches to quitting. For instance, your doctor may occasionally test your urine to make sure you aren't using tobacco.

Another option is a residential smoking-cessation program. In these programs, you stay at a treatment facility, sometimes a hospital, for a set number of days or weeks. During that time you participate in daily counseling sessions and other activities to help you deal with the cravings for cigarettes and to help you learn to live tobacco-free.


Exciting New Ideas

Researchers are studying the effectiveness of clot-busting drugs (thrombolytics) in reducing the risk of amputation in people with Buerger's disease. But this treatment is considered experimental.

In addition, research indicates that intravenous (IV) iloprost, a drug that increases blood flow, may provide more pain relief than aspirin does in people with Buerger's disease.

At this time, both of these treatments are available only in Europe.


By Mayo Clinic staff April 24th, 2010

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