Thromboangiitis Obliterans (Buerger's Disease):

The disease is typically encountered in heavy smokers, often before the age of 3
5 years.
Thromboangiitis obliterans is marked by segmental thrombosing, acute, and chroni
c inflammation of intermediate and small arteries and veins in the extremities.
It begins with nodular phlebitis, followed by Raynaud's-like cold sensitivity an
d leg claudication.
Acute lesions consist of neutrophilic infiltration of the arterial wall, with mu
ral or occlusive thrombi containing microabscesses, often with giant cell format
ion and secondary involvement of the adjacent vein and nerve.
Late lesions show organization and recanalization.
The cause is unknown.
The vascular insufficiency can lead to excruciating pain and ultimately gangrene
of the extremities.

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and-physiology.html
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Buerger's Disease
Buerger's disease (thromboangiitis obliterans) is the obstruction of small and m
edium-sized arteries and veins by inflammation triggered by smoking.
Men ages 20 to 40 who smoke cigarettes get Buerger's disease more than anyone el
se. Only about 5 percent of people with the disease are women. Although no one k
nows what causes Buerger's disease, only smokers get it, and continuing to smoke
makes it worse. Because only a small number of smokers get Buerger's disease, s
ome people must be more susceptible than others. Why and how cigarette smoke cau
ses the problem aren't known.
Symptoms
Symptoms of reduced blood supply to the arms or legs develop gradually, starting
at the fingertips or toes and progressing up the arms or legs, eventually causi
ng gangrene. About 40 percent of people with this disease also have episodes of
inflammation in the veins, particularly the superficial veins, and the arteries
of the feet or legs. People may feel coldness, numbness, tingling, or burning be
fore their doctor sees any signs. They often have Raynaud's phenomenon (see page
136 in this chapter) and get muscle cramps, usually in the arches of their feet
or in their legs but rarely in their hands, arms, or thighs. With more severe o
bstruction, the pain is worse and lasts longer. Early in the disease, ulcers, ga
ngrene, or both may appear. The hand or foot feels cold, sweats a lot, and turns
bluish, probably because the nerves are reacting to severe, persistent pain.
Diagnosis
In more than 50 percent of people with Buerger's disease, the pulse is weak or a
bsent in one or more arteries of the feet or wrists. Often, the affected hands,
feet, fingers, or toes become pale when raised above the heart and red when lowe
red. People may develop skin ulcers and gangrene, usually of one or more fingers
or toes.
Ultrasound tests reveal a severe decrease in blood pressure and blood flow in th
e affected feet, toes, hands, and fingers. Angiograms (x-rays of the arteries) s
how obstructed arteries and other circulation abnormalities, especially in the h
ands and feet.
Treatment
A person with this disease must stop smoking, or it will relentlessly worsen, an
d ultimately an amputation may be necessary. Also, the person should avoid expos
ure to the cold; injuries from heat, cold, or substances such as iodine or acids
used to treat corns and calluses; injuries from poorly fitting shoes or minor s
urgery (such as trimming calluses); fungal infections; and drugs that can narrow
blood vessels.
Walking 15 to 30 minutes twice a day is recommended, except for people with gang
rene, sores, or pain at rest; they may need bed rest. People should protect thei
r feet with bandages that have heel pads or with foam-rubber booties. The head o
f the bed can be raised on 6- to 8-inch blocks so gravity helps blood flow throu
gh the arteries. Doctors may prescribe pentoxifylline, calcium antagonists, or p
latelet inhibitors such as aspirin, especially when the obstruction results from
spasm.
For people who quit smoking but still have arterial occlusion, surgeons may impr
ove blood flow by cutting certain nearby nerves to prevent spasm. They seldom pe
rform bypass grafts, because the arteries affected by this disease are too small
.