Diagnosis of Buerger's disease (Thromboangiitis obliterans)

Buerger's disease is also called Throboangiitis obliterans, a disease in which the small and medium sized arteries gets occluded leading to ischemic ulcers which is difficult to heal. Smoking remains the key factor and it is often said that You can't have a leg if you smoke.

There are other risk factors too, details of which can be seen at Buerger's disease : A vascular disease in young smokers

Diagnosis of Buerger's disease depends on the proper history, clinical signs and symptoms and there are few investigations.

Distinguishing features of Buerger's diseae

The most important distinguishing feature of Buerger's disease is that there is no atherosclerotic changes in the arteries, there is no deposition of any plaques and the occlusion is without any pathology in the elastic lamina or arteries. There may not be any tenderness but the limbs may look red and edematous.

Symptoms of Buerger's disease

Symptoms of Buerger's disease include pain which may be intense due to ischemia or improper blood supply due to occlusion of blood vessels. There may be gangrenous ulceration of the foot, toes and fingers.

Intermittent claudication may be seen.

There may be superficial thrombophlebitis that is inflammation of the veins. This thrombophlebitis is migratory and the inflammation often migrate from one vein to other.

The limbs are generally cool, thogh pulse is felt but there may be tingling, numbness in both upper and lower limbs.

There may be Raynaud,s phenomenon that is blanching of hand and feet may be seen on exposure to cold and later dilatation of capillaries which may lead to edema.

Investigations for Buerger's disease

Though the above mentioned sign and symptoms in a young male who are smokers is sufficient to diagnose Buerger's disease but there are some investigations done to differentiate from other related diseases. These investigations are-

Blood test in Buerger's disease

Blood test is done to see erythrocyte sedimentation rate which is usually elevated in certain autoimmune diseases. Autoantibodies may be tested to differentiate it with certain diseases like scleroderma, Systemic lupus erythematosus (SLE), Rheumatoid vasculitis, mixed connective tissue disorders.

X Ray - Presence of cervical rib or carpal tunnel symdrome should be excluded by X ray.

Allens test for Buerger's disease

Allens test is done to detect the extent of occlusion of arteries. In this the patient is asked to make a tight fist and the artery is occluded by thumb of the doctor and then released, the back flow of blood in seen and thus estimated the occlusion.

Arteriography

Arteriography or angiography is done to visualise the occlusion of the arteries. Generally 3-4 arteries are involved in Buerger's disease. Arteriography may show a characteristic corrugation of the femaral arteries as well as the distal arterial occlusion and helps to distinguish the condition from presenile atherosclerosis. Arteriography also helps to exclude other forms or arteritis like poly arteritis nodosa, Juvenile temporal arteritis and other vasculitis.

As early the diagnosis is made better could be the outcome of treatment and lower will be the morbidity and mortality. The occlusion of artery is difficult to manage and sometimes amputation of the limb may be required to save the patient. Thus a proper treatment and preventive measure is required which is detailed in Treatment and prevention of Buerger's disease.

Diagnosis of Buerger's disease (Thromboangiitis obliterans)

Distinguishing features of Buerger's diseae

Symptoms of Buerger's disease

Investigations for Buerger's disease

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