A Family Doctor's Tale -BUERGER'S DISEASE

DOC I HAVE BUERGER'S DISEASE

Buerger's Disease is an uncommon form of arterial obstructive disease of the large and medium sized peripheral arteries of legs in men under age 40 giving rise to intermittent claudication.

Occasionally the arteries of the arms and the veins may be involved.

Causes of Buerger's Disease are:
1.heavy smoking

2.arterial lesions are inflammatory rather than degenerative.

3.The appearance is non-suppurative (no pus) panvasculitis

4.arterial obstructions in the legs are often associated with obstructive arterial lesion elsewhere(Example:angina pectoris)

5.Diabetes and high lipid patterns are aggravating factors.



Symptoms:

1.onset is sudden


2.classic symptom of heavy aching pain in the legs when walking(intermittent claudication)


3.loss of arterial pilses


4.leg pallor and coldness especially on raising the legs


5.Raynaud's phenomenon


6.Other arterial diseases:
a.retinopathy
b.coronary ischemia
c.renal ischemia


7.evidence of peripheral ischemia or gangrene

Diagnosis of  Buerger's Disease is by:

1.Symptoms and signs as above


2.pallor on raising legs


3.angiography to determine site of lesion

The complications of Buerger's Disease are


The complications are:
gangrene of the legs

Treatment of Buerger's Disease is by :


1.Patient is to stop smoking immediately


2.general measures:
a.graded exercise
b.physical training
c.weight loss


3.avoid injury from
a.heat
b.cold
c.trauma
d.infections

Medicines:
vasodilator drugs like persantin, nitrates

Surgery:
reconstructive surgery for localized blockage but may not work

Amputation is preferable with gangrene in elderly

Prevention for Buerger's Disease is by:


Avoiding smoking

Prognosis of Buerger's Disease:

The disease is often progressive and amputation may be necessary.