Buerger's Disease

Buerger disease, or thromboangiitis obliterans, is a segmental inflammatory disorder in which thrombus forms in small- and medium-sized arteries and veins, usually in the distal hands and feet. The inflamed vessel and clot narrow the lumen, so less oxygen reaches the digits. Exertional pain can progress to pain at rest, ulceration, and tissue death. The distribution helps distinguish it from typical atherosclerotic peripheral arterial disease. Atherosclerosis is driven by plaque in the arterial wall; Buerger disease primarily produces inflammatory thrombosis in smaller distal vessels. The two conditions can coexist, so a patient’s age or smoking history cannot establish the diagnosis by itself. Tobacco exposure is the major disease association and the most modifiable driver. Continuing to smoke allows vascular injury and thrombosis to continue. Complete tobacco cessation can arrest progression and substantially reduce the risk of tissue loss and amputation; cutting down is not equivalent to stopping.