What is Buerger's disease?

Abstract

In analyzing our observations of 115 patients with Buerger's disease during a recent 4-year period, the following results were obtained. First, Buerger's disease is primarily a disease of the small-and medium-sized vessels of the extremity. The disease commences peripherally and reaches the infrapopliteal or forearm arteries within a short time after the onset of symptoms. The majority of the patients have 3-or 4-limb involvement. Although the first ischemic manifestation is variable, a trophic lesion is the chief symptom at the first examination.Second, in contrast to an incessant deterioration of the peripheral circulation, proximal extension is less frequent. The skip lesion plays an important role in proximal progression of the obstructive lesion in the main artery.Third, although direct arterial surgery is infrequently feasible because of the distal occlusive process, successful arterial revascularization is most effective for healing of ulceration. All efforts should be concentrated on limb salvage.Furthermore, microabscess consisting of giant cells, epithelioid cells, and ieukocytes lends the most characteristic appearance to the thrombotic lesion at the early stage. General architecture of the vessel wall is well preserved at the healed stage.Finally, the etiology remains unknown. In this regard, however, we have a very strong clue in the astoundingly close relationship between the use of tobacco and the occurrence of the disease. If the patient absolutely abandons smoking, the natural history of the disease is uneventful.

Thromoboagiitis Obliterans (TAO)

“…Although the cause of TAO is still unknown, there is an extremely strong association between the heavy use of tobacco and TAO, and what precipitates the disease and determinates its course is smoking (12,13). It mainly affects young male smokers, although a few cases have been reported in ex-smokers and users of smokeless tobacco (14,15).…”

“…Claudication is a much less common complaint for patients with TAO than for patients with atherosclerosis. Whereas the clinical features show staged progression in the arterial insufficiency of atherosclerosis, in that of TAO, rest pain or ulceration does not always follow claudication (13). Ischemic rest pain and ulceration of the forefoot are the most frequently encountered clinical presentations.…”

“…Shionoya's criteria for making the diagnosis of TAO is based on 5 criteria (a smoking history, an onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, and the absence of atherosclerotic risk factors other than smoking). As there is no specific diagnostic test and an absence of positive serologic markers, a confident clinical diagnosis should be made only when all these 5 criteria have been fulfilled, although this is not universally accepted (13,19).…”

“…Although direct arterial surgery is usually not feasible, successful arterial revascularization is most effective for healing trophic lesion. A literature review revealed only a few series that reported on vascular reconstruction (mainly femorodistal bypasses) in patients with TAO (13). The bypass patency rates were suboptimal; however, the corresponding limb salvage rates were satisfactory.…”

Targeting novel antigens in the arterial wall in thromboangiitis obliterans.

“…Thromboangiitis obliterans (TAO), or Buerger's disease, is a non-atherosclerotic segmental, thrombotic, inflammatory disease most commonly affecting the small and medium sized arteries and veins of the upper and lower distal extremities [1][2][3][4]. The disease was proposed in 1908 by Buerger [1].…”