Buergers

Disease
Dr Putra Hendra SpPD
UNIBA
 Buergers Disease

Buerger's disease (thromboangiitis

obliterans) : combination of acute
inflammation and thrombosis of the
arteries and veins in the hands and feet.
The obstruction of blood vessels in the
hands and feet sakit dan kerusakan
jaringan ulkus dan gangren jari2.
Buergers Disease: Appearance
Ulcers and Gangrene caused by Buergers
Disease
 Epidemiologi

Dialami oleh 6 dari 10000 manusia

Biasanya pria umur 20-40 dan merokok
Banyak dialami penduduk asia, India dan
Timur tengah
 etiology
Tidak jelas
external factors: tobacco, cold or humid
weather, chronic trauma, infection
internal factors: immunologic
dysfunction
exposure to tobacco is essential for
both initiation and progression of the
disease.
 Pathology
1 begin with artery, then vein, from
distal to proximal.
2 segmental disease
3 in active stage, nonsuppurtive
inflammation
4 in end stage, intraluminal thrombosis
progressively organizes, new capillary
formation, vascular fibrosis
5 ischemic change
 Diagnosis
1 Age younger than 45 years, current (or
recent) history of tobacco use
2 Presence of distal-extremity ischemia
3 History of migratory superficial
thrombophlebitis
4 Impaired distal pulses.
5 Exclusion of autoimmune diseases,
hypercoagulable states, and diabetes mellitus
by laboratory tests
Buergers Disease: Symptoms
Enlarged, red, tender cord-like veins
Pain or tenderness
Numbness and tingling in the limbs
Skin ulcers or gangrene of the digits

Discoloration
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
 Clinical Features
Usually presents as claudication, rest pain

Features Atherosclerosis Buergers Ds

Age > 40yo 20-45yo
Other risk factors +++ no
Upper extremity
rare Up to 90%
involvement
Proximal vessel
+++ rare
involvement
Pulse exam decreased preserved
Superficial
no Up to 40%
Thrombophlebitis
 Clinical findings
1 The hands and feet are usually cool.
2 skin is pale, or cyanosis.
3 Paresthesias.
4 pain in limbs,
intermittent claudication
5 changes of nutritional dysfunction
 Clinical stage
First stage: local ischemic stage
Second stage: nutritional ischemic stage
Third stage: necrotic stage
 Special examination
1 Doppler examination
2 arteriography: formation of distinctive
small-vessel collaterals around areas of
occlusion known as "corkscrew
collaterals"
Normal and Abnormal Angiograms
 Buergers Disease:
Angiogram
Angiogram of the Hand

Normal In Buergers Disease

Buergers Disease: Treatment

Theonly method known to be an effective

treatment for Buerger's disease is
immediately quitting smoking. Patients who
continue to smoke after a diagnosis of
Buerger's disease will generally require
amputation of the fingers and toes.

Sincethere is no cure for Buerger's disease,

the goal of treatment is to control
symptoms.
 Treatment

1 General treatment
Absolute discontinuation of tobacco use
is the only strategy proven to prevent
the progression of Buerger disease.
prevent trauma and thermal or chemical
injury, avoidance of cold environments,
drugs that lead to vasoconstriction
Buerger exercise
 Medication

(1) vasodilators, antiplatelet drugs, and

anticoagulants
(2) antibiotics to treat infected ulcers
 3 hypertension oxygen treatment
4 surgical treatment
to improve distal arterial flow
(1) lumber sympathectomy
(2) vascular reconstructive procedures :
bypass transfer, thrombosis
Others: Omental transfer
Arteriovenous transfer
5 distal limb amputation for nonhealing
ulcers, gangrene
Buergers Disease: Prevention

To avoid the onset of Buerger's

disease, tobacco use should be
avoided, particularly by men.
Buergers Disease: Prognosis
Gejala dapat menghilang bila
merokok dihentikan is stopped.
Bila ada infection atau gangrene
mungkin perlu amputasi.
 Buergers Disease: Symptom
Control

Gentle massage and warmth to increase

circulation
Avoid conditions that reduce circulation to the
extremities
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 physician for appropriate
treatment
 Some People Just CANT Quit!
(Even if it costs an arm & a leg!)