Burgers Disease

Buerger’s Disease
(thromboangiitis obliterans) TAO

Buerger’s disease, also called thromboangiitis obliterans.
It is an inflammation of small- and medium-sized blood vessels.
Although any artery can be affected, it usually presents with
blockages of the arteries to the feet and hands, leading to pain and
tissue damage.
History
 Buerger's disease was first reported by Felix von

Winiwarter in 1879 in Austria.
 It was not until 1908, however, that the disease
was given its first accurate pathological
description, by Leo Buerger at Mount Sinai
Hospital in New York City. Buerger called it
"presenile spontaneous gangrene" after studying
amputations in 11 patients.
CAUSES
The specific cause of Buerger’s disease remains unknown.

 The risk for developing Buerger’s disease increases when
you smoke heavily. This includes cigarettes, cigars, chewing tobacco,
and snuff.
Some experts think that certain chemicals in tobacco might irritate
your blood vessels, and that’s what makes them swell. Others think it
may be an autoimmune response. This means tobacco triggers your
immune system to attack your blood vessels like they’re bad germs.
Epidemiology
The disease is found worldwide and can affect people of any race
and age group.
t is mainly affects Asian and Middle Eastern
Men between the ages of 40 and 45 who heavily use, or have
heavily used, tobacco products, including chewing tobacco
Buerger disease has become less common over the past ten
years given the decrease in smoking prevalence and more strict
diagnostic criteria.
 In 1947, it was estimated to occur in 104 out of 100,000 people.
It now is estimated to occur in 12-20 out of 100,000 people.
Risk factors
Tobacco use
Chronic gum disease
Sex
Age
Sign and symptoms
You may also notice changes in your hands and feet. They may:
Feel cold, numb, or tingly
Look pale, red, or blue in color
Your fingers and toes might:

Get painful, open sores
Turn pale when you’re cold (Raynaud’s phenomenon)
Sign and symptoms
recurrent acute and chronic inflammation
thrombosis of arteries and veins
of the hands and feet
Peripheral pulses are diminished or absent

Sign and symptoms
Colour may range from cyanotic blue
to reddish blue.
Skin becomes thin and shiny. Hair growth is reduced.

Ulcerations and gangrene in the extremities are
common complications.
Pathophysiology
There are characteristic pathologic findings of

acute inflammation and thrombosis (clotting) of arteries and veins of the hands
and feet (the lower limbs being more common).
The mechanisms underlying Buerger's disease are still largely unknown, but
smoking and tobacco consumption are major factors associated with it.
It has been suggested that the tobacco may trigger an immune response in
susceptible persons or it may unmask a clotting defect, either of which could incite
an inflammatory reaction of the vessel wall.
This eventually leads to vasculitis and ischemic changes in distal parts of limbs.
A possible role for Rickettsia in this disease has been proposed.

Diagnosis
A concrete diagnosis of thromboangiitis obliterans is often difficult as it
relies heavily on exclusion of other conditions. The commonly followed
diagnostic criteria are outlined below although the criteria tend to differ
slightly from author to author.
Olin (2000) proposes the following criteria:
Typically between 20–40 years old and male, although recently
females have been diagnosed.
Current (or recent) history of tobacco use.
Presence of distal extremity ischemia (indicated by claudication, pain at
rest, ischemic ulcers or gangrene) documented by noninvasive vascular
testing such as ultrasound.
Exclusion of other autoimmune diseases, hypercoagulable states, and
diabetes mellitus by laboratory tests.
Exclusion of a proximal source of emboli by echocardiography and
arteriography.
Consistent arteriographic findings in the clinically involved and noninvolved
limbs.
Angiography- or arteriography is a medical imaging technique used
to visualize the inside, or lumen, of blood vessels and organs of the
body, with particular interest in the arteries, veins, and the heart
chambers.
An echocardiogram uses sound waves to create pictures of
your heart's chambers, valves, walls and the blood vessels
(aorta, arteries, veins) attached to your heart. A probe
called a transducer is passed over your chest.
Treatment
 Smoking cessation has been shown to slow the progression of the
disease and decrease the severity of amputation in most patients,
but does not halt the progression.
 Treatment by 100% hyperbaric oxygen.
Amputation -is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure,
it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene.
 In acute cases, drugs and procedures which cause vasodilatation
are effective in reducing pain experienced by patient. For
example, prostaglandins like Limaprostare vasodilators and give
relief of pain, but do not help in changing the course of disease.
 Epidural anaesthesia and hyperbaric oxygen therapy also have
vasodilator effect.
 In chronic cases, lumbar sympathectomise may be occasionally
helpful. It reduces vasoconstriction and increases blood flow to
limb. It aids in healing and giving relief from pain of ischemic
ulcers.
 Bypass can sometimes be helpful in treating limbs with poor
perfusion secondary to this disease. Use of vascular growth factor
and stem cell injections have been showing promise in clinical
studies
 Debridement is done
in necrotic ulcers.
 In gangrenous digits , amputation is frequently required. Above-

knee and below-knee amputation is rarely required.
 Despite the clear presence of inflammation in this disorder, anti-
inflammatory agents such as corticosteroids have not been shown to
be beneficial in healing, but do have significant anti-inflammatory
and pain relief qualities in low dosage intermittent form
 Similarly, strategies of anticoagulation have not proven effective.
physical therapy: interferential current therapy to decrease
inflammation
PREVENTION
*Quit using tobacco in any form*

 Virtually everyone who has Buerger's disease has
used tobacco in some form, most prominently
cigarettes. To prevent Buerger's disease, it's
important to not use tobacco.
 Quitting smoking can be hard. If you're like most
people who smoke, you've probably tried to quit
in the past. It's never too late to try again. Talk to
your doctor about strategies to help you quit.
Prognosis
 Buerger's is not immediately fatal.
 Amputation is common and major amputations
(of limbs rather than fingers/toes) are almost
twice as common in patients who continue to
smoke.
 Prognosis markedly improves if a person quits
smoking.
NURSING INTERVENTION
 Patient teaching, instruct the patient to do the following several

times a day:
– Lie flat on a bed with both legs elevated above the level of the
heart for two to three minutes.
– Next sit on the edge of the bed with the legs dependent for
three minutes
– Then exercise the feet and toes by moving them up, down,
inward, then outward.
– Lastly, return to the first position and hold for five minutes.
 Provide for ulcer debridement and healing
 Remove dead or damaged material from the wound, using wet-
to-dry dressing with saline solution and coarse-mesh gauze filled
with cotton.
 Use whirlpool therapy to debride the ulcer bed.
 Consider using an enzymatic debrider to aid removal of
debris.
 Provide additional intervention to promote venous return
and healing, maximize comfort and provide client education
for measures to prevent venous stasis ulcer.
 Administer medications which may include antibiotics.
 The patient is encouraged to make the lifestyle changes
necessitated by the onset of a chronic disease, including
pain management and modifications in diet, activity, and
hygiene (skin care).
 The nurse assists the patient in developing and
implementing a plan to stop using tobacco.
THANK YOU

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Buerger’s Disease

(thromboangiitis obliterans) TAO

 Buerger's disease was first reported by Felix von

The specific cause of Buerger’s disease remains unknown.

Your fingers and toes might:

recurrent acute and chronic inflammation

Peripheral pulses are diminished or absent

Skin becomes thin and shiny. Hair growth is reduced.

There are characteristic pathologic findings of

This eventually leads to vasculitis and ischemic changes in distal parts of limbs.

A possible role for Rickettsia in this disease has been proposed.

 In gangrenous digits , amputation is frequently required. Above-

Quit using tobacco in any form

 Patient teaching, instruct the patient to do the following several

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