Buerger's Disease

Buerger's disease, also called thromboangiitis obliterans (TAO), is a segmental, nonatherosclerotic inflammatory disease of small and medium arteries and veins in the distal arms and legs. The vessel lumen becomes blocked by a highly cellular inflammatory thrombus, while the vessel wall is relatively spared and the internal elastic lamina remains preserved. Distal blood flow falls, producing claudication, rest pain, ischemic ulcers, and eventually gangrene. Tobacco exposure is the near-universal association. This is not the usual atherosclerotic pattern caused by age, diabetes, hypertension, or dyslipidemia; patients with TAO often have normal-to-low lipid profiles. Continued exposure to tobacco or nicotine can keep the inflammatory process active, even when exposure seems small. Onset is usually in early or middle adulthood, often between approximately 20 and 50 years of age. Historical male predominance is narrowing as tobacco use among women increases. Age and sex support the pattern, but tobacco exposure combined with distal ischemia is more clinically informative than either demographic feature alone.