Buerger's disease is a non-atherosclerotic, inflammatory disease that causes blockages in the small and medium arteries and veins of the limbs, especially the legs. It is strongly associated with tobacco use and is characterized by recurring blood clots and inflammation within blood vessels that supply the arms and legs. The main symptoms are pain, discoloration, and ulcers in the legs that worsen with walking or standing. Treatment focuses on complete cessation of tobacco use and medications or surgery to improve blood flow.

1. BUERGER’S DISEASE
AJM

2. “Thromboangitis Obliterans is a distinctive
disease that leads to vascular insufficiency,
characterised by segmental, thrombosing,
acute and chronic inflammation of medium
sized and small arteries and sometimes
secondarily extending into the veins and
nerves”.
Leo Berger, 1879-1943,
Professor of Urology, NYPMS, NY, USA,
Described TAO in 1908

3. RISK FACTORS:
• CIGARETTE SMOKING:
– Most consistent aspect of this disorder.
– Hypersensitivity to intradermally injected tobacco
extracts.
– Increased prevalence of HLA-A9 and HLA-B5 in
these patients
– Common in India, Japan & Israel pointing to its
genetic influences!.
• SEX

5. MORPHOLOGY:
• Sharply segmental acute and chronic vasculitis
of medium and small arteries.
MICROSCOPY:
• Inflammation permeates the arterial walls.
• Thrombosis of the lumen.
• May undergo organisation or recanalisation.
• Thrombus contains microabscesses.
• Characteristic migratory recurrent superficial
phlebitis.

7. CLINICAL FEATURES
• The patient generally complains of pain while
walking at the arch of the foot.
• Onset – Age: 20 -40 yrs. Spontaneous and
gradual
• Intermittent claudication, which progresses to
‘rest pain’.
• Swelling redness and slight pain
• Postural dependency  Trophic changes 
Ulceration  Gangrene.
• DD: Raynaud’s disease, Senile gangrene

9. PHYSICAL EXAMINATION
Local examination:
INSPECTION:
1.Change in color.
2.Signs of ischemia
3.Buerger’s postural test.
4.Capillary filling time
5.Venous refilling

10. PALPATION:
1.PALPATION OF BLOOD VESSELS.
2.CAPILLARY REFILLING.
3.VENOUS REFILLING.
4.ALLEN’S TEST.
5.COLD AND WARM WATER TEST.
6.NEUROLOGICAL EXAMINATION.

11. INVESTIGATIONS
• BLOOD
• URINE
• STRAIGHT X-RAY
• ARTERIOGRAPHY:
I. RETROGRADE PERCUTANEOUS
CATHETERISATION.
II. DIRECT ARTERIAL PUNCTURE.

13. • DETERMINATION OF BLOOD VELOCITY BY
ULTRASOUND DOPPLER.
• ISOTOPE TECHNIQUE
• BLOOD LIPIDS.
• INVESTIGATION FOR VASOSPASM
– Brown’s vasomotor Index.
• PLETHYSMOGRAPHY.

15. MANAGEMENT
• CESSATION OF SMOKING CAN ARREST THE
DISEASE.
• MEDICAL
– CILOSTAZOL
– PENTOXIFYLLINE
• SURGICAL
– TRANSLUMINAL ANGIOPLASTY & STENTING(PTE,
PTFE).
– BYPASS GRAFTS.