Buerger's disease is also named as thromboangiitis obliterans. It is a rare and severe damage of blood vessels and nerves without a clear cause. The condition usually occurs in young men under 40 years of age.
The mechanism of disease is unknown, but there is a strong suspicion that smoking plays an extremely important factor in the development of disease. A genetic precondition is probably also present and in combination with tobacco smoking it starts the pathological process. The principle of Buerger's disease is a non-infectious inflammation of blood vessel walls (so-called vasculitis) that is associated with formation of blood clots in the arteries and veins (usually in lower extremities). The arteries begin to close. In some cases chronic ongoing inflammation may lead to a conversion of vessels and nerves into non-functional fibrous bands.
The disease manifests by lack of oxygen in body parts supplied by narrowed arteries. Usually pain of upper and lower extremities is present. The pain is initially dependent on exertion (higher tissue oxygen consumption) but later it is permanent. Poorly oxygenated tissues are prone to skin defect formations and bacterial infections. Gangrene is the most serious complication.
It is a challenge to properly diagnose Buerger's disease because of its rarity; an angiologist is usually the doctor who confirms the suspicion. The diagnosis is bases on above mentioned symptoms, clinical examination and vascular angiography. We do not find atherosclerotic narrowing typical for classic lower limb ischemic disease, but artery closures caused by blood clots. In places of obstruction there are spiraling newly formed blood vessels that are try to bridge the closures.
A causative treatment doesn't exist, but smoking cessation proved to have a great effect on patient's prognosis. Some weaker anti-clotting drugs are used with mixed results. If the closure is located in a favorable spot, a surgical bridging can be created (so-called bypass). In case of serious complication such as gangrene occurrence, an amputation must be performed.