1. Buerger’s Disease A presentation by Jennifer Kent-Baker

2. Buerger’s Disease: What It Is Buerger's disease (thromboangiitis obliterans) is a rare disease characterized by a combination of acute inflammation and thrombosis of the arteries and veins in the hands and feet. The obstruction of blood vessels in the hands and feet reduces the availability of blood to the tissues, causes pain and eventually damages or destroys the tissue. It often leads skin ulcerations and gangrene of fingers and toes. Rarely, in advanced stages of the disease, it may affect vessels in other parts of the body.

3. Buerger’s Disease: Appearance Ulcers and Gangrene caused by Buerger’s Disease

4. Buerger’s Disease: Who It Affects Buerger's disease affects approximately six out of every 10,000 people. It almost always affects men, ages 20 to 40, who smoke or chew tobacco. Recently, however, more women and men over the age of 50 have been diagnosed with Buerger's disease. This disorder is still very uncommon in children, but it may occur in those with autoimmune diseases. Buerger's disease is most common in the Orient, Southeast Asia, India and the Middle East, but is rare among African-Americans.

5. Buerger’s Disease: Symptoms Enlarged, red, tender cord-like veins Pain or tenderness Numbness and tingling in the limbs Skin ulcers or gangrene of the digits Discoloration Two or more limbs affected Pain may increase with activity such as walking and decrease with rest Pulse may be decreased or absent in the affected extremity Symptoms may worsen with exposure to cold or with emotional stress

6. Buerger’s Disease: The Cause Buerger's disease is greatly associated with heavy to moderate tobacco use, both cigarette and smokeless. The disease is an autoimmune reaction triggered by tobacco.

7. Buerger’s Disease: Diagnosing Buerger's disease is often masked by a wide variety of other diseases that cause diminished blood flow to the hands and feet, therefore, other disorders must be ruled out with aggressive evaluation. Blockage of blood vessels in the hands and feet caused by Buerger's disease may be detected by one of the following methods: An angiogram or an arteriogram of the upper and lower extremities A Doppler ultrasound Skin biopsies are rarely used because of concern that the biopsy site near an area with poor blood circulation will not heal.

8. Normal and Abnormal Angiograms

9. Buerger’s Disease: Angiogram Angiogram of the Hand Normal In Buerger’s Disease

10. Buerger’s Disease: Prevention To avoid the onset of Buerger's disease, tobacco use should be avoided, particularly by men.

11. Buerger’s Disease: Treatment The only method known to be an effective treatment for Buerger's disease is immediately quitting smoking. Patients who continue to smoke after a diagnosis of Buerger's disease will generally require amputation of the fingers and toes. Since there is no cure for Buerger's disease, the goal of treatment is to control symptoms.

12. Buerger’s Disease: Symptom Control Gentle massage and warmth to increase circulation Avoid conditions that reduce circulation to the extremities Avoid sitting or standing in one position for long periods Do not walk barefoot to avoid injury Do not wear tight or restrictive clothing Report all injuries to physician for appropriate treatment

13. Buerger’s Disease: Prognosis The symptoms of Buerger's disease may disappear if tobacco use is stopped. If the affected extremity is to be saved, the patient must stop smoking. If infection or gangrene occurs, amputation of the affect extremity may be necessary.

14. Some People Just CAN’T Quit! (Even if it costs an arm & a leg!)