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Buerger's disease, a 'young' disease for older people, a 'smoking' disease for non-smokers

Abraham Eisenstein, M.D. |
Buerger's disease or thromboangiitis obliterans was spotted back in 1908 when inflammation and thrombosis of arteries and veins was described.

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cute inflammation and clotting of arteries and veins in the hands and feet leads to some nasty symptoms that start with tingling or numbness in the hands or feet.

After that, Buerger's symptoms include reddish or blue hands or feet, pain that comes and goes and it can be strong, pain that stops when the patient is at rest, fingers and toes that become pale in cold conditions, and painful open sores on fingers and toes.

Now, a young cigarette smoker 20 to 40 years old, male, is what we would call a typical patient. The disease is most common in Asia, the Middle East and the Orient, all places historically connected with smoking. But, more and more older people, over 50, and women have been diagnosed with Buerger's disease, so it's not about young smokers only anymore.

Furthermore, an interesting thing, from a medical point of view, was noticed: While lack of blood flow to the distant extremities occurs, other organs are spared. We could, in a sense, expect clotting to expand over time to other body systems but it doesn't happen: even when the patient develops a hard clinical picture with gangrene in the finger, other organs are not affected. We don't know why is that, but we and the patient may be thankful for that.

What's the connection between smoking and Buerger's disease?

Well, things are not simple. Since the typical patient is a heavy smoker, that leads to "Do not smoke!" as the main advice from various support groups, but there are heavy smoker, moderate smokers, those who chew tobacco and there are people who never saw a cigarette in the life.

Thus, we can say smoking may increase the risk for the disease but it's not a deciding factor. Buerger’s disease is defined as an autoimmune reaction: some element in tobacco triggers some reaction in which the body attacks itself. But, what about non-smokers?

Buerger’s disease may be similar to other diseases (some examples are atherosclerosis, endocarditis, lupus...), so the diagnosis must be 100% accurate because their treatments are very different.

Angiograms of arms and legs can tell us a lot, then we might find "corkscrew" arteries, and we may find blockages in the arm or legs.

What's the treatment?

Unfortunately, the only advice is: stop smoking if you do. If you don't, there are other options such as drugs to dilate blood vessels or compression of the arms and legs to increase blood flow. Unfortunately, if the disease progresses to reach gangrene, an amputation must be performed.

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