Vascular disease is any condition that affects the circulatory system and ranges from diseases of your arteries, veins, and lymph vessels to blood disorders that affect circulation.  With every beat of our hearts, oxygen rich blood is pumped through blood vessels called the circulatory system to every part of the body.  Arteries carry blood away from the heart to the rest of our body while veins return it.  When any part of the circulatory system is weakened by disease, there is a loss or shortage of blood flow to various parts of the body which can lead to anything from pain in the legs to aneurysms or loss of limbs.  Seventy percent of all amputations are not due to diabetes or trauma but because of some form of vascular disease.  We’re going to explore Buerger’s disease, the effects, and causes and how to avoid or treat it.

Buerger’s disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms and legs.  It usually first shows in the small arteries, veins and nerves of the hands and feet and may eventually affect larger areas of your arms and legs.  With this disease your blood vessels become inflamed, swell and can become blocked with blood clots.  The cells that cause the inflammation and 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.  The lack of oxygen and nutrients eventually leads to severe tissue damage and gangrene.  Signs and symptoms of gangrene (tissue death) 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.

Symptoms of Buerger’s disease include pain that may come and go in your legs and feet or in your arms and hands.  The pain typically occurs when you use your hands or feet and eases when you stop that activity.  Other symptoms include inflammation along a vein just below the skin’s surface caused by a blood clot in the vein, painful open sores on fingers or toes, and fingers and toes that turn pale when exposed to the cold.  Those with Buerger’s disease often suffer from chronic gum disease as well.

While the cause is unknown, it’s possible that some people may have a genetic predisposition to the disease.   There is a strong association with tobacco use or exposure and it’s believed that chemicals in tobacco may irritate the lining of blood vessels causing them to swell.  Buerger’s disease usually affects men younger than 40 years of age, though it’s becoming more common in women.  It is more common in the Middle East and Far East where heavy smoking is common place but there are cases in the United States.  Almost everyone diagnosed with Buerger’s disease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco.  Cigarette smoking greatly increases your risk of Buerger’s disease.  Heavy cigarette smokers which are categorized as 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.

There is no cure but quitting all forms of tobacco is the only way to stop Buerger’s disease from progressing.  Those who don’t quit-amputation of all or part of a limb is usually necessary.  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 as second hand smoke could worsen your condition.  Other less effective treatments include spinal cord stimulation, medications to dilate blood vessels, improve blood flow or dissolve blood clots and intermittent compression of the arms and legs to increase blood flow to your extremities.   Other treatments include surgery to cut the nerves to the affected area to control pain and increase blood flow, although this procedure is controversial and sometimes arterial bypass surgery which replaces damaged veins with healthy ones taken from another part of the body.

Those diagnosed with Buerger’s disease have to take care to not expose fingers and toes to the cold and have to check these areas daily to avoid infection of cuts they may not feel due to numbness.  They also have to visit the dentist regularly since chronic gum disease is directly linked to Buerger’s disease.  If you think you may have Buerger’s disease, it is important to speak with your doctor to rule out any other causes of your symptoms and confirm a diagnosis.   Your doctor may need to perform an angiogram to find out how big the blockage is and what course of treatment to take.  Talk with your doctor about smoking cessation programs or medications available to you.