What happens in the vessels
With Buerger's disease, the entire wall of an artery or small-caliber vein becomes inflamed, and an inflammatory thrombus forms in the lumen. Unlike atherosclerosis, there are no cholesterol plaques, and large vessels remain passable for a long time. The lesion is segmental in nature: areas of blockage alternate with normal segments of the vessel. The body tries to compensate for the lack of blood flow in roundabout ways, but with the small caliber of the vessels this does not work well, so the most distant areas - the toes and hands - suffer.
- Inflammation of the entire vessel wall
- Blood clots without cholesterol plaques
- Damage to small and medium-sized arteries and veins
- Segmental nature of the blockage
- The feet and hands are most often affected
- Possible migrating superficial thrombophlebitis
Causes and risk factors
The exact mechanism is not fully understood, but a connection with tobacco can be traced in almost all patients. It's not just cigarettes: chewing tobacco, snuff, hookah and electronic heating systems also support the disease. It is assumed that tobacco components trigger immune inflammation of the inner lining of blood vessels in susceptible people. Mostly young men are affected, although the proportion of women has been increasing in recent decades. Hypothermia, foot injuries and tight shoes further worsen the course.
- Smoking in any form is a key factor
- Male gender
- Age up to 45 years
- Genetic predisposition
- Hypothermia of the extremities
- Chronic injuries and tight shoes
Symptoms
The first complaints are increased chilliness, pallor and numbness of the fingers, cramps in the feet. Then intermittent claudication appears: when walking, pain occurs in the muscles of the foot or lower leg, which forces you to stop, and goes away after rest. As the pain progresses, the distance decreases, and eventually the pain begins to bother you at rest, intensifying at night in a horizontal position. The skin becomes dry, thin, nails thicken, and hair on the legs falls out. Painful ulcers and areas of necrosis appear on the fingers.
- Coldness and numbness of fingers
- Intermittent claudication, often in the foot
- Pain at rest, worse at night
- Pallor and blueness of fingers in the cold
- Dry skin, hair loss, brittle nails
- Non-healing ulcers and necrosis of fingertips
- Painful lumps along the saphenous veins
Diagnostics
The doctor examines the limbs, checks the pulsation of the arteries in the feet and wrists, and assesses the color and temperature of the skin. The main instrumental method is duplex ultrasound examination of the arteries, showing the level and extent of blockage. CT angiography or angiography clarifies the anatomy before possible intervention and reveals the characteristic pattern of tortuous bypass vessels. An important part of the examination is the exclusion of other causes: atherosclerosis, diabetes mellitus, systemic vasculitis, thrombophilia and sources of embolism in the heart.
- Inspection and palpation of the pulse in the arteries
- Duplex scanning of the arteries of the extremities
- Ankle-brachial index measurement
- CT angiography of arteries
- Analyzes: glucose, lipids, inflammation indicators
- Examination to exclude vasculitis and embolism
Treatment and prevention
The only method proven to stop the disease is a complete cessation of tobacco in all forms, including second-hand smoke. If you continue to smoke, any treatment is temporary. The doctor prescribes medications that improve microcirculation and reduce pain, and, if necessary, pain relief and wound treatment. Surgical restoration of blood flow is not always possible, since small vessels are affected. Careful foot care, warm, loose shoes, and avoidance of hypothermia and injury are important. In case of gangrene, economical amputation is performed.
- Immediate and complete cessation of tobacco
- Help in overcoming nicotine addiction
- Drugs that improve microcirculation
- Pain relief and ulcer treatment
- Dosed walking as recommended by a doctor
- Warm, loose shoes, protecting feet from injury
- Revascularization or cost-saving amputation as indicated
