Buerger's disease

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Buerger's disease

Postby patoco » Thu Oct 12, 2006 8:51 am

Buerger's disease

Lymphedema People

http://www.lymphedemapeople.com

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There are a number of vascular conditions that may mimick lymphedema, even appearing with similar complications.

One such condition is called Buerger's disease. A patient with Buerger's may even have limbs that become red, painful and swollen and may confuse this with cellulitis or a bacterial infection.

Remember however, lymphedema is a condition of the lymph system, not of the cardio-vascular system and it is important to distinguish the differences between Buerger's disease and lymphedema.

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From Question and Answer - National Lymphedema Network - Lymphlink

July-September 2004

Paula J.B. Stewart, MS, MD

Q: I am a 39-year-old female smoker who was told recently by my doctor that I have Buerger's Disease. My symptoms are red, painful feet and mild-to-moderate swelling. I also suffer from Raynaud's syndrome and have blue painful fingers in the cold. Are these conditions related and can I treat the swelling like lymphedema?

A: Buerger's smoking disease is related to smoking or chewing tobacco, which causes vaso-constriction of the smaller arteries of the hands and feet. The constriction can progress to the point of causing ulcers and gangrene. The condition most often affects young men 20-40 years of age. It is curable by discontinuing smoking. Sadly, many of those with Buerger's continue to smoke and ultimately end up with an amputation.

Other treatment options include the use of calcium channel blockers to reduce vaso-constriction. These can cause increased edema as a side effect of the medication and must be used with caution. This edema is primarily inflammatory and can respond to anti-inflammatory medications, however the COX-II inhibitors (such as Vioxx and Celebrex) can cause additional swelling and must be used cautiously. Finally, low compression stockings can be of benefit. However, it would be important to obtain an ABI or ankle-brachial index to measure arterial compromise. If the ABI is less than .5, no compression should be initiated. If more than .5, compression of 8-15 mmHg can be safely used for the patient's comfort.

Raynaud's is associated with Buerger's syndrome in 50% of the cases. It is thought that some component of tobacco–either nicotine and/or carbon monoxide–sensitizes the vasculature to constrict excessively, given a stimulus such as cold or stress.

http://www.lymphnet.org/lymphedemaFAQs/ ... _07_04.htm

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Buerger's Disease

What is Buerger's disease?

Buerger's disease (also known as thromboangiitis obliterans) is a rare disease characterized by a combination of acute inflammation and thrombosis (clotting) of the arteries and veins in the hands and feet. The obstruction of blood vessels in the hands and feet reduces the availability of blood to the tissues, causes pain and eventually damages or destroys the tissue. It often leads skin ulcerations and gangrene of fingers and toes. Rarely, in advanced stages of the disease, it may affect vessels in other parts of the body.

Who is affected by Buerger's disease?

Buerger's disease affects approximately six out of every 10,000 people. It almost always affects men, ages 20 to 40, who smoke or chew tobacco. Recently, however, more women and men over the age of 50 have been diagnosed with Buerger's disease. This disorder is still very uncommon in children, but it may occur in those with autoimmune diseases. Buerger's disease is most common in the Orient, Southeast Asia, India and the Middle East, but is rare among African-Americans.

What are the symptoms of Buerger's disease?

Symptoms of Buerger's disease appear in the hands and feet and may include:

Enlarged, red, tender cord-like veins
Pain or tenderness
Numbness and tingling in the limbs
Skin ulcers or gangrene of the digits (fingers, toes)
Discoloration
Symptoms that may worsen with exposure to cold or emotional stress
Two or more limbs affected
Pain may increase with activity such as walking and decrease with rest
Pulse may be decreased or absent in the affected extremity

Symptoms may worsen with exposure to cold or with emotional stress

What causes Buerger's disease?

Buerger's disease is greatly associated with heavy to moderate tobacco use (both cigarette and smokeless). The disease is an autoimmune reaction (one in which the body's immune system attacks the body's own tissue) triggered by tobacco.

How is Buerger's disease diagnosed?

Buerger's disease is often masked by a wide variety of other diseases that cause diminished blood flow to the hands and feet. Because of this, other disorders must be ruled out with aggressive evaluation. Blockage of blood vessels in the hands and feet caused by Buerger's disease may be detected by one of the following methods:

An angiogram or an arteriogram of the upper and lower extremities
A Doppler ultrasound

Skin biopsies, however, are rarely used because of concern that the biopsy site near an area with poor blood circulation will not heal.

Can Buerger's Disease be prevented?

To avoid the onset of Buerger's disease, men should avoid tobacco use.

How is Buerger's disease treated?

The only method known to be an effective treatment for Buerger's disease is immediate smoking cessation. Patients who continue to smoke after a diagnosis of Buerger's disease will generally require amputation of the fingers and toes.

Since there is no cure for Buerger's disease, the goal of treatment is to control symptoms. Some measures include:

Gentle massage and warmth to increase circulation
Avoid conditions that reduce circulation to the extremities, such as cold temperatures)
Avoid sitting or standing in one position for long periods
Do not walk barefoot to avoid injury
Do not wear tight or restrictive clothing
Report all injuries to your physician for appropriate treatment

What is the prognosis for a patient with Buerger's disease?

The symptoms of Buerger's disease may disappear if tobacco use ceases. If the affected extremity is to be saved, the patient must stop smoking. If infection or gangrene occurs, amputation of the affect extremity may be necessary.

http://www.med.umich.edu/1libr/aha/umcirc08.htm

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Buerger’s Disease

First Description

This disease was first reported by Buerger in 1908, who described a disease in which the characteristic pathologic findings — acute inflammation and thrombosis (clotting) of arteries and veins — affected the hands and feet. Another name for Buerger’s Disease is thromboangiitis obliterans.

Who gets Buerger's Disease (the “typical” patient)?

The classic Buerger’s Disease patient is a young male (e.g., 20–40 years old) who is a heavy cigarette smoker. More recently, however, a higher percentage of women and people over the age of 50 have been recognized to have this disease. Buerger’s disease is most common in the Orient, Southeast Asia, India and the Middle East, but appears to be rare among African–Americans.

Classic symptoms and signs of Buerger's Disease

The initial symptoms of Buerger’s Disease often include claudication (pain induced by insufficient blood flow during exercise) in the feet and/or hands, or pain in these areas at rest. The pain typically begins in the extremities but may radiate to other (more central) parts of the body. Other signs and symptoms of this disease may include numbness and/or tingling in the limbs and Raynaud’s phenomenon (a condition in which the distal extremities — fingers, toes, hands, feet — turn white upon exposure to cold). Skin ulcerations and gangrene (pictured below) of the digits (fingers and toes) are common in Buerger’s disease. Pain may be very intense in the affected regions.

Despite the severity of ischemia (lack of blood flow) to the distal extremities that occurs in Buerger’s, the disease does not involve other organs, unlike many other forms of vasculitis. Even as ulcers and gangrene develop in the digits, organs such as the lung, kidneys, brain, and gastrointestinal (GI) tract remain unaffected. The reasons for the confinement to the extremities and sparing of other organs are not known.

What Causes Buerger's Disease?

The association of Buerger’s Disease with tobacco use, particularly cigarette smoking, cannot be overemphasized. Most patients with Buerger’s are heavy smokers, but some cases occur in patients who smoke “moderately”; others have been reported in users of smokeless tobacco. It has been postulated that Buerger’s Disease is an “autoimmune” reaction (one in which the body’s immune system attacks the body’s own tissues) triggered by some constituent of tobacco.

How is Buerger's diagnosed?

Buerger’s disease can be mimicked by a wide variety of other diseases that cause diminished blood flow to the extremities. These other disorders must be ruled out with an aggressive evaluation, because their treatments differ substantially from that of Buerger’s Disease (for Buerger’s, there is only one treatment known to be effective: complete smoking cessation — see below).

Diseases with which Buerger’s Disease may be confused include atherosclerosis (build–up of cholesterol plaques in the arteries), endocarditis (an infection of the lining of the heart), other types of vasculitis, severe Raynaud’s phenomenon associated with connective tissue disorders (e.g., lupus or scleroderma), clotting disorders of the blood, and others.

Angiograms of the upper and lower extremities can be helpful in making the diagnosis of Buerger’s disease. In the proper clinical setting, certain angiographic findings are diagnostic of Buerger’s. These findings include a “corkscrew” appearance of arteries that result from vascular damage, particularly the arteries in the region of the wrists and ankles. Angiograms may also show occlusions (blockages) or stenoses (narrowings) in multiple areas of both the arms and legs.

In order to rule out other forms of vasculitis (by excluding involvement of vascular regions atypical for Buerger’s), it is sometimes necessary to perform angiograms of other body regions (e.g., a mesenteric angiogram).

Skin biopsies of affected extremities are rarely performed because of the frequent concern that a biopsy site near an area poorly perfused with blood will not heal well.

Treatment and Course of Buerger's

It is essential that patients with Buerger’s disease stop smoking immediately and completely. This is the only treatment known to be effective in Buerger’s disease. Patients who continue to smoke are generally the ones who require amputation of fingers and toes.

Despite the clear presence of inflammation in this disorder, anti-inflammatory agents such as steroids have not been shown to be beneficial. Similarly, strategies of anticoagulation (thinning of the blood with aspirin or other agents to prevent clots) have not proven effective. The only way to prevent the progression of the disease is to abstain from all tobacco products.

*Excellent diagnostic images

http://vasculitis.med.jhu.edu/typesof/buergers.html
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