Buerger’s disease is a rare disease of the small and medium sized blood vessels of extremities that causes them to get inflamed, swollen, and blocked. Clots, known as thrombi, can form in the lumen of blood vessels. As a result, blood flow to the hands and feet is reduced to the point where it damages the skin tissues and causes deterioration known as gangrene. The disease can move up the arms and legs after starting in the hands and feet. Buerger’s disease is also known as thromboangiitis obliterans (TAO).
The single most important risk factor for Buerger’s disease is use of tobacco, either as cigarettes, chewing tobacco, or second hand or passive smoking. Other risk factors include cold weather, stress, and health conditions that limit the lumen of blood arteries, such as collagen diseases or atherosclerosis. Moreover, having a family member with the condition may increase the risk.
Causes
The exact cause of Buerger’s illness remains unknown. However, the swelling and inflammation are thought to be caused by vasculitis, in which the body’s defensive system, known as the immune system, automatically causes the inflammation. This disorder is also thought to have a genetic propensity. The inflammation, swelling, and blockage are precipitated by cigarette smoking or use of tobacco products in any form. The toxins in tobacco products are said to cause spam and narrowing of the blood vessels, hence causing the symptoms of Buerger’s disease.
Symptoms
Pain is the most common initial sign. The pain worsens when using the hands and feet and appears to go away with rest. This is referred to as claudication. The superficial blue blood capillaries that bring blood from the extremities to the heart can become inflamed, making them visible and painful to touch. When exposed to cold, the fingers and toes may turn pale. This is called the Raynaud’s phenomenon. There may also be a tingling sensation. This happens because cold causes spasm of the blood vessels supplying blood to the extremities. As the skin tissues are starved of blood, painful sores and ulcers may form. Gangrene is caused by a persistent lack of blood circulation to the skin. The tips of the fingers and toes may turn black, and the damage caused is irreversible.
Complications
The most feared complication of Buerger’s disease is gangrene. The skin overlying the affected part becomes blue or black, loses sensation, and may smell foul.Since it is permanent damage of skin tissues, it may require permanent removal of the affected parts surgically, known as amputation. Ulcers on the legs and arms may also become infected. Muscles in nearby region go weak and may waste away over time.
Diagnosis
Buerger’s disease is a high possibility in a smoker who complains of intermittent pain that comes with activity and settles with rest. The doctor may then do Allen’s test to determine the rate of blood flow in the arms. The patient is asked to make a fist to create pressure in the blood vessels, thereby pressing his or her hand’s blood vessel until the hand goes pale. This pressure is then gradually relieved, allowing blood to flow into the hand. The speed at which the blood flows and changes colour is then recorded. An angiography or arteriogram is another test that may be performed. In this a dye is injected into the body such that it flows down to the blocked vessels. X-ray images are then taken to study the flow through the vessels. This is a reliable test that can detect even the earliest signs of sickness. An ultrasound can be used to examine the blood flow characteristics. Blood tests may be done for ruling out other conditions like clotting disorders, or diabetes, and to study the activity of the immune system.
Treatment
Giving up smoking and other tobacco products can halt the disease. Medicines may be prescribed to dilate the blood vessels or dissolve the clots. Certain medications can cause the formation of new blood vessels (therapeutic angiogenesis). To decrease discomfort and promote blood flow, surgery may be performed to sever the nerves of the affected location. However, the role of medicine and surgery is not very well defined. Amputation may be required if an ulcer or gangrene persists.
Prevention
The best prevention is to quit tobacco in any form. Medical help and community and family support should be sought to quit smoking. Complications can be prevented by exercising precaution. Extremes of cold should be avoided. Footwear and gloves may provide warmth. Shoes should be comfortable and well fitting. Cotton socks should be preferred to those made in synthetic material. Soft padding may be placed inside the shoes for protection. Walking with bare feet should be avoided. The extremities should be checked for ulcers on a regular basis, and sensation must be monitored at all times. If an ulcer or reduced sensations emerge, seek immediate medical attention. Moderate physical activity can be done after seeking medical advice. A good nutritious diet should be taken. Smoking is deleterious for your limbs. Quit now.
