Buerger's disease is a non-atherosclerotic vasculitis characterized by the occlusion of small and medium-sized arteries

Aetiology

• Smoking: tobacco use is the most significant risk factor for Buerger's disease
  • The disease is strongly associated with heavy smoking, particularly cigarettes made from unprocessed tobacco leaves
• The combination of smoking and an abnormal immune response appears to be central to the development of Buerger's disease
  • Immunological factors, genetic predisposition and endothelial dysfunction have all been implicated

Clinical features

• Typically presents as an acutely ischaemic limb without a background of peripheral claudication
• Symptoms may include severe pain in the affected limb, especially in the hands and feet
• Raynaud's phenomenon, characterized by color changes in the digits upon exposure to cold or stress, is frequently observed
• Ulcers or non-healing wounds on the fingers and toes, often associated with gangrene
• Superficial migratory thrombophlebitis, which refers to inflamed veins that appear as tender, reddish, cord-like structures under the skin

Investigations

• Investigations aim to exclude other differentials such as atherosclerotic disease and autoimmune disorders
• Key investigations include:
  • Arterial doppler: this test is used to confirm the absence of peripheral pulses in the affected limb
    • Buerger's disease typically presents with diminished or absent pulses distal to the occlusion
  • Arterial duplex: further imaging using arterial duplex helps visualize the vascular structures and can identify the characteristic collateral vessels associated with Buerger's disease
    • Martorell's sign on arterial duplex describes the 'corkscrew'-shaped collateral vessels
  • CT/MR angiography: these imaging techniques provide detailed images of the blood vessels, assisting in the visualization of non-atherosclerotic occlusion and assessing the extent of the disease

Management

• Smoking cessation
• Vasoactive medications such as nifedipine may be used as adjunctive treatments to improve blood flow and reduce symptoms