Buerger disease

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Related to Buerger disease: Raynaud's disease, Berger disease

throm·bo·an·gi·i·tis ob·li·te·rans

inflammation of the entire wall and connective tissue surrounding medium-sized arteries and veins, especially of the legs of young and middle-aged men; associated with thrombotic occlusion and commonly resulting in gangrene.

Buer·ger dis·ease

(bĕr'gĕr di-zēz')
Pain in extremities similar to those caused by intermittent claudication in association with medial arterial sclerosis. Also affects small veins and the lymphatic system. Almost wholly male preponderance; related to tobacco use, cold, malnutrition, and vascular collagen disorders.
Synonym(s): Billroth-von Winiwarter disease, endoarteritis obliterans, Winiwarter-Manteuffel-Buerger disease.

Buerger disease

Abbreviation: BD
A chronic, recurring, inflammatory, but nonatheromatous vascular occlusive disease, chiefly of the peripheral small and medium-sized arteries (and sometimes veins) of the extremities causing decreased blood flow to the feet and legs. Occasionally the hands are also affected, causing painful ulceration of the fingertips. The disease is seen most commonly in males 20 to 40 years of age who smoke cigarettes or chew tobacco. Synonym: thromboangiitis obliterans


Symptoms include paresthesias of the foot, easy fatigability, and foot and leg cramps. In patients with severely limited blood flow to the legs, skin ulceration or moist gangrene of the extremities may develop. Amputation is sometimes needed to remove dead tissue.


Absolute, permanent abstinence from tobacco in all forms is crucial. The patient should avoid excessive use of the affected limb, exposure to temperature extremes, use of drugs that diminish the blood supply to extremities, trauma, and fungus infections. Aspirin and vasodilators may be prescribed. If gangrene, pain, or ulceration is present, complete bedrest is advised with a padded foot-board or bed cradle to prevent pressure on the extremities; if these are absent, the patient should walk at a comfortable pace for 30 min twice daily. For arterial spasm, blocking of the sympathetic nervous system by injection of various drugs or by sympathectomy may be done.

Patient care

The history should document occurrences of painful, intermittent claudication of the instep, calf, or thigh, which exercise aggravates and rest relieves; the patient's walking ability (distance, time, and rest required); the patient's foot response to exposure to cold temperatures (initially cold, numb, and cyanotic; later reddened, hot, and tingling); and any involvement of the hands, such as digital ischemia, trophic nail changes, painful fingertip ulcerations, or gangrene. Peripheral pulses are palpated, and absent or diminished radial, ulnar, or tibial pulses documented. Feet and legs are inspected for superficial vein thrombophlebitis, muscle atrophy, peripheral ulcerations, and gangrene, which occur late in the disease. Soft padding is used to protect the feet, which are washed gently with a mild soap and tepid water, rinsed thoroughly, and patted dry with a soft towel. The patient is instructed in this daily care routine and advised to inspect tissues for injury such as cuts, abrasions, and signs of skin breakdown (redness or soreness) and to report all injuries to the health care provider for treatment. The patient is advised to avoid wearing tight or restrictive clothing, sitting or standing in one position for long periods, and walking barefoot; also, shoes and cotton or woolen stockings should be carefully fitted, but stockings should not be tight enough to hinder venous return from the legs. He should obtain medical care following any local trauma. Extremities must be protected from temperature extremes, esp. cold. The patient is taught the Buerger postural exercises if prescribed and is cautioned to avoid use of over-the-counter drugs without the attending health care provider's approval. The patient who smokes is referred to a smoking cessation program, but nicotine patch therapy should not be prescribed given the patient's associated hypersensitivity to nicotine. For the patient with ulcers and gangrene, bedrest is prescribed; a padded footboard or cradle is used to prevent pressure from bed linens. If hospitalization is required for treatment of ulcers or gangrene, or if amputation is required, rehabilitative needs are considered, esp. regarding changes in body image, and the patient is referred for physical and occupational therapy and for social services as appropriate.

See also: Buerger, Leo


Leo, Austrian-U.S. physician, 1879-1943.
Buerger disease - inflammation of the entire wall and connective tissue surrounding medium-sized arteries and veins, associated with thrombotic occlusion and commonly resulting in gangrene. Synonym(s): thromboangiitis obliterans; Winiwarter-Buerger disease
Buerger exercises - exercises specifically for patients with arterial insufficiency of their lower limbs. Synonym(s): Buerger-Allen exercises
Buerger-Allen exercises - Synonym(s): Buerger exercises
Winiwarter-Buerger disease - Synonym(s): Buerger disease