Buergers disease: Difference between revisions

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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information, click [[Buerger's disease (patient information)|here]]'''


{{Infobox_Disease |
  Name          = Buerger's disease |
  Image          = Buerger's Disease.JPG|
  Caption        = Buerger's Disease of the Hand|
  DiseasesDB    = 1762 |
  ICD10          = {{ICD10|I|73|1|i|70}} |
  ICD9          = {{ICD9|443.1}} |
  ICDO          = |
  OMIM          = 211480 |
  MedlinePlus    = |
  MeshName      = Thromboangiitis+Obliterans |
  MeshNumber    = C14.907.137.870 |
}}
{{Buerger's disease}}
{{Buerger's disease}}
{{CMG}}
{{CMG}};{{AE}}{{HM}}


{{SK}} Thromboangiitis obliterans; Winiwarter-Buerger disease; Buerger disease; Endarteritis obliterans


:''Not to be confused with [[Berger's disease]] (IgA nephropathy)''
'''Not to be confused with [[Berger's disease]] (IgA nephropathy)'''


==Overview==
==[[Buerger's disease overview|Overview]]==
'''Buerger's disease''' (also known as '''''thromboangiitis obliterans''''') is an acute [[inflammation]] and [[thrombosis]] (clotting) of [[artery|arteries]] and [[vein]]s of the hands and feet. It is strongly associated with use of [[tobacco]] products,<ref>{{cite journal | author=Joyce JW | title=Buerger's disease (thromboangiitis obliterans). | journal=Rheum Dis Clin North Am | year=1990 | pages=463-70 | volume=16 | issue=2 | id=PMID 2189162 }}</ref> primarily from [[Tobacco smoking|smoking]], but also from smokeless tobacco.  It is more often seen in men. There may be an autoimmune element as well.  Raynaud’s phenomenon, ulcers and pain are typically seen.  Immediate termination of smoking is essential.
==[[Buerger's disease historical perspective|Historical Perspective]]==


==Features==
==[[Buerger's disease pathophysiology|Pathophysiology]]==
There is a recurrent acute and chronic [[inflammation]] and [[thrombosis]] of [[artery|arteries]] and [[vein]]s of the hands and feet. The main symptom is [[Pain and nociception|pain]] in the affected areas. [[Ulceration]]s and [[gangrene]] in the extremities are common [[Complication (medicine)|complication]]s, often resulting in the need for [[amputation]] of the involved extremity.
==[[Buerger's disease causes|Causes]]==
==[[Buerger's disease differential diagnosis|Differentiating Buerger's Disease from other Diseases]]==


==[[Buerger's disease epidemiology and demographics|Epidemiology and Demographics]]==
==[[Buerger's disease risk factors|Risk Factors]]==
==[[Buerger's disease natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==Diagnosis==
==Diagnosis==
A concrete diagnosis of thromboangiitis obliterans is often difficult as it relies heavily on exclusion of the conditions. The commonly followed diagnostic criteria are below although the criteria tend to differ slightly from author to author. Olin (2000) proposes the following criteria:<ref>Olin JW. ''Thromboangiitis obliterans (Buerger's disease).'' N Engl J Med 2000;343:864-9. PMID 10995867.</ref>
[[Buerger's disease criteria|Diagnostic Criteria]] | [[Buerger's disease history and symptoms|History and Symptoms]] | [[Buerger's disease physical examination|Physical Examination]] | [[Buerger's disease laboratory findings|Laboratory Findings]] | [[Buerger's disease echocardiography or ultrasound|Ultrasound ]] | [[Buerger's disease other imaging findings|Other Imaging Findings]] | [[Buerger's disease other diagnostic studies|Other Diagnostic Studies]]
# Age younger than 45 years
# Current (or recent) history of tobacco use
# Presence of distal extremity ischemia (indicated by claudication, pain at rest, ischemic ulcers or gangrene) documented by noninvasive vascular testing such as ultrasound
# Exclusion of autoimmune diseases, hypercoagulable states, and diabetes mellitus by laboratory tests.
# Exclusion of a proximal source of emboli by echocardiography and arteriography
# Consistent arteriographic findings in the clinically involved and noninvolved limbs.
 
==Diagnostic Findings==
 
<div align="left">
<gallery heights="175" widths="175">
Image:Upper burgers1.jpg|Thromboangiitis Obliterans (Buerger's disease): Arterial vascular disease associated with smoking. Note the blackened tips of middle and pinky fingers. <br> (Image courtesy of Charlie Goldberg, M.D.)
</gallery>
</div>
 
==Pathophysiology==
There are characteristic [[pathology|pathologic]] findings of acute [[inflammation]] and [[thrombosis]] (clotting) of [[artery|arteries]] and [[vein]]s of the hands and feet (the lower limbs being more common). The mechanisms underlying Buerger's disease are still largely unknown. It is suspected that [[immunology|immunological]] reactions play a role.


==Treatment==
==Treatment==
Symptoms are treated as there is no treatment for the disease. Cessation of tobacco use may slow any further progression of the disease.  [[Vascular surgery]] can sometimes be helpful in treating limbs with poor perfusion secondary to this disease.  Use of vascular growth factor and stem cell injections have been showing promise in clinical studies.
[[Buerger's disease medical therapy|Medical Therapy]] | [[Buerger's disease surgery|Surgery]] | [[Buerger's disease primary prevention|Primary Prevention]] | [[Buerger's disease cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Buerger's disease future or investigational therapies|Future or Investigational Therapies]]
 
==Prognosis==
Amputation is common and more severe in patients who continue to use tobacco. It often leads to vascular insufficiency.  Buerger's is rarely immediately fatal, but rather a life shortening disease.
 
==Prevention==
The cause of the disease is unknown but heavily linked to tobacco use.  There have also been links to persons with digestive disorders.
 
==Epidemiology==
Buerger's is more common among men than women. It is more common in Israel, Japan and India along the "old silk route" than in the United States and Europe. The disease is most common among South Asians, who often smoke  cigarettes made of raw tobacco ([[bidi]]s).
 
==History==
Buerger's disease was first reported by Felix Von Winiwater in 1879 in Germany. <ref>von Winiwarter F: Ueber eine eigenthumliche Form von Endarteriitis und Endophlebitis mit Gangran des Fusses. Arch Klin Chir 1879; 23: 202-26.</ref>
 
It was described in detail by [[Leo Buerger]] in 1908 in New York,<ref>Buerger L. ''Thrombo-angiitis obliterans: a study of the vascular lesions leading to presenile spontaneous gangrene.'' Am J Med Sci 1908;136:567-80.</ref> who called it presenile spontaneous gangrene after studying amputations in 11 patients.
 
===Pathology===
<youtube v=whJF412vi2g/>
 
==References==
 
{{Reflist|2}}
 
==External Links==
 
[http://www.microsurgeon.org/buergers_disease.htm Buerger's Disease]]


==Case Studies==
[[Buerger's disease case study one|Case #1]]
{{Circulatory system pathology}}
{{Circulatory system pathology}}


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[[zh:血栓闭塞性脉管炎]]
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Latest revision as of 16:05, 12 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Synonyms and keywords: Thromboangiitis obliterans; Winiwarter-Buerger disease; Buerger disease; Endarteritis obliterans

Not to be confused with Berger's disease (IgA nephropathy)

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Buerger's Disease from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria | History and Symptoms | Physical Examination | Laboratory Findings | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1


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