Thromboangiitis obliterans

Answer 1

Definition

Thromboangiitis obliterans is a rare disease in which blood vessels of the hands and feet become obstructed.

Alternative Names

Buerger's disease

Causes, incidence, and risk factors

Thromboangiitis obliterans (Buerger's disease) is caused by vasculitis (inflammation of the blood vessels).

The blood vessels of the hands and feet are especially affected, becoming constricted or totally blocked. This reduces blood flow to the hand and foot tissues, resulting in pain and eventually damage.

Thromboangiitis obliterans affects about 6 of every 10,000 people. It almost always affects men ages 20 to 40 who have a history of smoking or chewing tobacco.

The condition may also be associated with a history of Raynaud's disease.

This disorder is very uncommon in children, but may occur in those with autoimmune diseases.

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

Note: Symptoms may worsen with exposure to cold or with emotional stress. Usually, two or more limbs are affected.

Signs and tests

The hands or feet may show enlarged, red, tender blood vessels. The pulse in the affected hands or feet may be low or absent.

The following tests may show blockage of blood vessels in the affected hands or feet:

• An angiography/arteriography of the extremity
• A Doppler ultrasound of the extremity

Blood tests for other causes of vasculitis and inflammation may be done. Rarely, in cases where the diagnosis is unclear, a biopsy of the blood vessel is done.

Treatment

There is no cure for thromboangiitis obliterans. The goal of treatment is to control symptoms.

To prevent amputation, the patient must stop using tobacco and should avoid cold temperatures and other conditions that reduce circulation to the hands and feet.

Applying warmth and exercising gently may help increase circulation.

Cutting the nerves to the area (surgical sympathectomy) may help control pain. Aspirin and vasodilators may also used. Amputation of the extremity may be necessary if infection or extensive tissue death occurs.

Expectations (prognosis)

Symptoms of thromboangiitis obliterans may disappear if the person stops tobacco use. For some, amputation is unavoidable.

Complications

• Amputation
• Gangrene (tissue death)
• Loss of circulation beyond the affected extremity

Calling your health care provider

Call your health care provider if you have symptoms of thromboangiitis obliterans, if you have thromboangiitis obliterans and symptoms get worse despite treatment, or if new symptoms develop.

Prevention

Those with a history of Raynaud's disease or thromboangiitis obliterans should avoid all tobacco use.

References

Olin JW. Other peripheral arterial diseases. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 80.

Answer 2

Definition

Thromboangiitis obliterans is a rare disease in which blood vessels of the hands and feet become blocked.

Alternative Names

Buerger's disease

Causes, incidence, and risk factors

Thromboangiitis obliterans (Buerger's disease) is caused by vasculitis (inflammation of the blood vessels).

The blood vessels of the hands and feet are especially affected. They tighten or become totally blocked. The average age when symptoms begin is around 35 years. Woman and older adults are affected less often.

Thromboangiitis obliterans mostly affects men ages 20 to 40 who have a history of heavy smoking or chewing tobacco. Only 1 out of 10 patients are women.

The condition may also be related to a history of Raynaud's disease.

This disorder is very uncommon in children, but it may occur in children with autoimmune diseases.

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

Note: Symptoms may worsen with exposure to cold or with emotional stress. Usually, two or more limbs are affected.

Signs and tests

The hands or feet may have large, red, tender blood vessels. The pulse in the affected hands or feet may be low or missing.

The following tests may show blockage of blood vessels in the affected hands or feet:

• Angiography/arteriography of the extremity
• Doppler ultrasound of the extremity

Blood tests for other causes of vasculitis and inflammation may be done. Rarely, in cases where the diagnosis is unclear, a biopsy of the blood vessel is done.

Treatment

There is no cure for thromboangiitis obliterans. The goal of treatment is to control symptoms.

The patient must stop using tobacco and should avoid cold temperatures and other conditions that reduce circulation to the hands and feet.

Applying warmth and exercising gently may help increase circulation.

Cutting the nerves to the area (surgical sympathectomy) may help control pain. Aspirin and vasodilators may also used. It may be necessary to amputate the hand or foot if infection or widespread tissue death occurs.

Expectations (prognosis)

Symptoms of thromboangiitis obliterans may disappear if the person stops tobacco use. For some, amputation is unavoidable.

Complications

• Amputation
• Gangrene(tissue death)
• Loss of circulation beyond the affected hand or foot

Calling your health care provider

Call your health care provider if:

• You have symptoms of thromboangiitis obliterans
• You have thromboangiitis obliterans and symptoms get worse, even with treatment
• You develop new symptoms

Prevention

Those with a history of Raynaud's disease or thromboangiitis obliterans should avoid all tobacco use.

References

Olin JW. Other peripheral arterial diseases. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 80.

Reviewed By

Review Date: 03/18/2011

A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Ariel D. Teitel, MD, MBA, Chief, Division of Rheumatology, St. Vincent's Hospital, New York, NY. Review provided by Verimed Healthcare Network (11/5/2010).