Diagnostic Criteria and Treatment of Buerger’s Disease: A Review

Abstract

Buerger's disease is an inflammatory occlusive disorder affecting the small and medium-size arteries and veins of young, predominantly male, smokers. The disorder has been identified as an autoimmune response triggered when nicotine is present. Tobacco abuse is the major contributing risk factor; however, smoking seems to be a synergistic factor rather than the cause of the disease. The traditional diagnosis of Buerger's disease is based on 5 criteria (smoking history, onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, and absence of atherosclerotic risk factors other than smoking). As there is no specific diagnostic test and an absence of positive serologic markers, confident clinical diagnosis should be made only when all these 5 criteria have been fulfilled although not universally accepted. The angiographic findings in Buerger's disease ("corkscrew," "spider legs," or "tree roots") are helpful but not pathognomonic. A wide spectrum of medical or surgical therapeutic options have been proposed; however, total abstinence from tobacco use remains the only means of stopping the disease progression. The initial management of patients with Buerger's disease should be conservative. Because several arteries may be unaffected, claudicants should be encouraged to walk, whereas patients with "critical" ischemia should be admitted for bed rest in the hospital. Bypass grafting is seldom an option, as the location of the lesions distally leaves little to bypass because of lack of target vessels. A literature review revealed only a few series reporting vascular reconstruction (mainly femorodistal bypasses) in Buerger's disease. Bypass patency rates were suboptimal; however, the corresponding limb salvage rates were satisfactory. A possible explanation is that patent grafts, even over a short period of time, are sufficient to allow healing of ulcers in patients with Buerger's disease.

Colon Ischemia Associated with Buerger's Disease: Case Report and Review of the Literature

“…8 However, a higher percentage of women and people over the age of 50 have been recognized to have this disease. 9 The main symptom is pain in the affected areas.…”

Buerger’s Disease (Thromboangiitis Obliterans)- Management by Ilizarov’s Technique of Horizontal Distraction. A Retrospective Study of 60 Cases

“…Its long term role in chronically dilated ischaemic vessls is also questionable [2,20]. Direct revascularization surgeries are not possible due to diffuse involvement and absence of distal target vessel [2, 12,15,21]. Graft failure is high [22] but can be attempted with impending gangrene and a target vessel [23].…”

Regions of Arterial Stenosis and Clinical Factors Determining Transcutaneous Oxygen Tension in Patients with Peripheral Arterial Disease

“…The pathophysiological manifestations of ASO and Buerger's disease differ. Patients with ASO often have risk factors for atherosclerosis, such as diabetes mellitus, smoking, hypertension, and dyslipidemia, while patients with Buerger's disease are often free of such risk factors except smoking 17,18) . Furthermore, arterial lesions are often found in both the proximal and peripheral segments of leg arteries in patients with ASO, while they are often confined to the peripheral segment in patients with Buerger's disease.…”

“…Fifty-six patients were eventually diagnosed with PAD, including 49 cases of arteriosclerosis obliterans (ASO) and 7 of thromboangiitis obliterans (TAO; Buerger's disease). Buerger's disease was diagnosed according to criteria described elsewhere 17,18) . PAD patients included the following: Fontaine , 12 patients; Fontaine , 34 patients; Fontaine , 4 patients; Fontaine , 6 patients.…”