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Thromboangiitis Obliterans

(Buerger Disease; Buerger's Disease)

By John W. Hallett, Jr., MD

Thromboangiitis obliterans is inflammation and subsequent blockage of small and medium-sized arteries of the legs or arms.

  • Thromboangiitis obliterans commonly develops in smokers.

  • Symptoms are those of reduced blood flow to an extremity: coldness, numbness, tingling or a burning sensation.

  • Ultrasonography is often used to detect decreased blood flow in the affected extremity.

  • Stopping smoking is the most important part of treatment.

  • People may also need to take drugs.

Thromboangiitis obliterans is a rare type of occlusive peripheral arterial disease that usually develops in smokers, most commonly in men aged 20 to 40. Thromboangiitis obliterans was once considered a man’s disease, but it is becoming increasingly common among women who smoke. Now, about 5% of people with the disease are women, perhaps because more women are smoking.

How cigarette smoking relates to thromboangiitis obliterans is poorly understood, and what causes the disease is unknown. One theory is that smoking triggers inflammation and constriction of arteries. However, only a small number of smokers develop thromboangiitis obliterans. Some people may be more susceptible than others for as yet unknown reasons. Nonetheless, thromboangiitis obliterans invariably worsens in people who continue to smoke, and amputation is commonly required. In contrast, if people with thromboangiitis obliterans quit smoking, amputation is rarely required.


Usually, symptoms of a reduced blood supply to the arms or legs develop gradually. Symptoms include

  • Coldness

  • Numbness

  • Tingling or burning sensation

  • Pain

These abnormal sensations start at the fingertips or toes and progress up the legs or arms. The legs are affected more often than the arms. People may feel abnormal sensations before their doctor sees any skin changes indicating an inadequate blood supply (ischemia) or gangrene. Raynaud syndrome and muscle discomfort during exertion ( intermittent claudication) may develop. Cramps occur in the calf muscles or feet if the legs are affected and in the hands or forearms if the arms are affected.

As the disease progresses, cramps become more painful and last longer. Late in the disease, skin ulcers, gangrene, or both may appear, usually on one or more toes or fingers. The foot or hand feels cold and may turn bluish, probably because blood flow is greatly reduced.

Some people with thromboangiitis obliterans also have episodes of inflammation in the veins (migratory phlebitis), usually in the superficial veins.


  • A doctor's evaluation of symptoms

  • Ultrasonography

Usually, doctors suspect thromboangiitis obliterans on the basis of symptoms and results of the physical examination. In most people, the pulse is weak or absent in one or more arteries of the feet or wrists. Often, the affected hands, feet, fingers, or toes become pale when raised above the heart and red when lowered.

Ultrasonography detects a substantial decrease in blood pressure and blood flow in the affected feet, toes, hands, and fingers. Angiography can detect specific patterns of narrowing and thus can help confirm the diagnosis.

Sometimes a biopsy (removal of a tissue sample for examination under a microscope) of the affected artery or referral to a specialist is needed to confirm the diagnosis.


  • Stopping smoking

  • Sometimes drugs or surgery

Stopping smoking immediately is essential, or symptoms will relentlessly worsen. Amputation is then likely to become necessary.

Avoiding exposure to cold, which causes blood vessels to narrow (constrict), and use of certain drugs should be avoided. These drugs include those that cause blood vessels to constrict (such as ephedrine, pseudoephedrine, or phenylephrine, which are components of some sinus congestion and cold remedies) and those that increase the tendency of blood to clot (such as estrogen in birth control pills or hormone replacement therapy).

Preventing injury to the affected leg or arm is important. People should take care to avoid burns and injuries due to cold or minor surgery (such as trimming calluses). Corns and calluses should be treated by a podiatrist. Wearing shoes that fit well and have wide toe spaces can help prevent injury to the feet.

Drugs, such as iloprost, may help prevent amputation in people who quit smoking but still have blocked arteries. Other drugs, such as pentoxifylline and calcium channel blockers, may be tried to help open blood vessels but are probably not very effective.

Surgery may be done to cut certain nearby nerves (a procedure called sympathectomy) and prevent blood vessels from constricting. These procedures are seldom done because they usually improve blood flow only temporarily.

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