Buerger disease, Thromboangiitis obliterans

Buerger disease, also known as thromboangiitis obliterans, is a nonatherosclerotic, inflammatory disease that most commonly affects the small and medium-sized arteries and veins in the upper and lower extremities. Cigarette smoking has been implicated as the main etiology of the disease. Although Buerger's disease has a worldwide distribution, it is more prevalent in the Middle East and Far East and classically develops in male smokers younger than 45 years. There may be a predisposition to development of Buerger's disease, although no gene has been identified to date. The most common symptom is pain at rest and claudication in the affected hands or feet. Other symptoms include cold insensitivity, diminished peripheral pulses, cyanosis, skin atrophy, and reduced hair growth. As the disease progresses, patients will develop ischemic ulcerations and eventually gangrene. Abstinence from smoking is the definitive treatment to prevent disease progression. Medical line of treatment with vasodilators, pentoxyfylline, and cilostazol may help improve pain-free walking distance but cannot prevent disease progression. Surgical treatment in form of revascularization and sympathectomy increases peripheral blood flow and decreases the rate of amputations. Newer therapy with prostaglandins, bosentan, and stem cell therapy has shown promising results.