Overview
Thromboangiitis Obliterans is a rare disease in which blood vessels of the hands and feet become obstructed.
What Causes It ?
The cause of the disease is not fully understood but it is probable that the smoking triggers thrombosis in the blood vessels, leading to a lack of oxygen and nutrients to the affected tissue. Research has demonstrated the presence of immunoglobulins and endothelial cell antibodies suggesting an immunological mechanism. The blood level of these antibodies can be used as a marker of disease activity. Response to acetylcholine (a chemical which leads to relaxation of blood vessels) has also been shown to be decreased in Buerger patients compared to normal subjects.
In some cases, thromboangiitis obliterans has been associated with chronic arsenic poisoning.
What Tests Are Necessary ?
A skin biopsy can be helpful although the features are not specific for thromboangiitis obliterans. The histology usually shows intraluminal thrombosis (blood clot within the vessel) with associated microabscess formation. A mixed infiltrate of white bloods cells and giant cells may be seen in all layers of the vessel wall, although the internal elastic lamina is classically spared and helps distinguish thromboangiitis obliterans from other types of vasculitis. Tests to rule out the presence of other diseases such as diabetes, clotting disorders, connective tissue disease, atherosclerosis and embolism are usually performed.
A scan of the limb arteries (arteriogram) may be performed and is likely to show normal proximal vessels (these are the ones closest to the body) but multiple narrowings and occlusions distally (closest to the hands and feet). Many new bypass-vessels (corkscrew collaterals) often develop in an attempt to maintain blood supply.
Symptoms
- Hands or feet may be pale, red, or bluish
- Hands or feet may feel cold
- Pain in the hands and feet
- Acute, severe
- Burning or tingling
- Often occurring at rest
- Pain in the legs, ankles, or feet when walking (intermittent claudication)
- Often located in the arch of the foot
- Skin changes or ulcers on hands or feet
Treatments And Drugs
No treatments can cure Buerger's disease. Instead, your doctor may try various treatment approaches to reduce any signs and symptoms you have.
Options include:
- Counseling or medications to help you stop smoking and stop the swelling in your blood vessels
- Medications to improve blood flow or to dissolve blood clots
- Surgery to cut the nerves in the affected area (surgical sympathectomy) to control pain
- Amputation, if infection or gangrene occurs
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