Thromboangiitis obliterans is a rare disease in which blood vessels of the hands and feet become blocked.

Buerger disease

Thromboangiitis obliterans (Buerger disease) causes small blood vessels to become inflamed and swollen. The blood vessels then narrow or get blocked by blood clots (thrombosis). Blood vessels of the hands and feet are mostly affected. Arteries are more affected than veins. Average age when symptoms begin is around 35. Women and older adults are affected less often.

This condition mostly affects men ages 20 to 45 who are heavy smokers or chew tobacco. Female smokers may also be affected. The condition affects more people in the Middle East, Asia, the Mediterranean, and Eastern Europe. Many people with this problem have poor dental health, most likely due to tobacco use.

Symptoms most often affect 2 or more limbs and may include:

• Fingers or toes that appear pale, red, or bluish and feel cold to the touch.
• Sudden severe pain in the hands and feet. The pain may feel like a burning or tingling sensation.
• Pain in the hands and feet that most often occurs when at rest. The pain may be worse when the hands and feet get cold or during emotional stress.
• Pain in the legs, ankles, or feet when walking (intermittent claudication). The pain is often located in the arch of the foot.
• Skin changes or small painful ulcers on the fingers or toes.
• Occasionally, arthritis in the wrists or knees develops before the blood vessels become blocked.

There is no cure for thromboangiitis obliterans. The goal of treatment is to control symptoms and prevent the disease from getting worse.

Stopping tobacco use of any kind is key to controlling the disease. Smoking cessation treatments are strongly recommended. It is also important to avoid cold temperatures and other conditions that reduce blood flow in the hands and feet.

Applying warmth and doing gentle exercises can help increase circulation.

Aspirin and medicines that open the blood vessels (vasodilators) may help. In very bad cases, surgery to cut the nerves to the area (surgical sympathectomy) can help control pain. Rarely, bypass surgery is considered in certain people.

It may become necessary to amputate the fingers or toes if the area becomes very infected and tissue dies.

Symptoms of thromboangiitis obliterans may go away if the person stops tobacco use. People who continue to use tobacco may need repeated amputations.

Complications include:

• Tissue death (gangrene)
• Amputation of fingers or toes
• Loss of blood flow in the limb of the affected fingers or toes

Contact your health care provider if:

• You have symptoms of thromboangiitis obliterans.
• You have thromboangiitis obliterans and symptoms get worse, even with treatment.
• You develop new symptoms.

People with a history of Raynaud phenomenon or blue, painful fingers or toes, especially with ulcers, should not use any form of tobacco.

Published Date: July 22, 2024
Published By: Neil J. Gonter, MD, Assistant Professor of Medicine, Columbia University, NY and private practice specializing in Rheumatology at Rheumatology Associates of North Jersey, Teaneck, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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