Buerger's Disease: Causes, Symptoms, Treatment and Cost

Buerger's disease is a rare condition that affects the arteries and veins in the arms and legs. It is caused by inflammation of tiny blood vessels, which in turn results in blockages. This blockage prevents blood from flowing properly through the arms and legs, resulting in pain, swelling and tissue damage.

There are generally three types of Buerger’s disease: classic Buerger’s disease, atypical Buerger’s disease and hypercoagulable state-associated Buerger’s disease.

• Classic Buerger’s Disease: Classic Buerger's Disease affects small- and medium-sized arteries and arterioles of the limbs resulting in vascular spasm or occlusion leading to death of tissue beyond the point of occlusion. This is caused by inflammation that causes an accumulation of leukocytes (white cells). In addition to death of tissue beyond the point of occlusion or thrombosis (clotting), there may also be ulcerations on feet and hands with varying degrees of severity.
• Atypical Buerger’s Disease: Atypical Buerger's Disease affects larger vessels outside the upper limb while still causing ulcerations on hands and feet with varying degrees of severity but no thrombosis involved unlike classic types of this illness. It differs from classic type because it doesn't limit itself just up until certain points like classic does - it can affect vessels everywhere including proximal parts (arms).
• Hypercoagulable State-Associated Buerger’s Disease: Hypercoagulable state-associated Buerge'rs Disease involves an increase in clot forming elements within blood vessels due a history cardiac event or other associated disorder(disorder unrelated to original damage). People who experience this type are more likely to develop clots in their limbs when compared to other individuals affected with this condition due to the possibility of over activity among various elements within their bloodstream (platelets, fibrinogen etc.)

Common causes include:

• Smoking
• Family history
• Age
• Gender
• Genetic factors.

• Exposure to lead or other toxic substances.
• Physical trauma
• Excessive alcohol consumption.

• Pain in extremities: Buerger's Disease causes throbbing, burning, or cramping pain in the arms and legs.
• Skin ulcers: Wounds that heal slowly may indicate Buerger's Disease on the lower limbs or feet.
• Coldness, paleness and discoloration of extremities: These are caused by reduced circulation due to blocked arteries.
• Tissue death/gangrene: Gangrene is a serious condition where lack of blood supply leads to tissue death in parts of the body, often the toes and fingers.
• Changes in nail beds: Buerger's Disease can cause changes in nail beds with clubbing or puffiness of digits due to poor blood flow leading to tissue death (gangrene).
• Modification in pulse: Changes in pulse rate may be felt due to narrowing or blockages of blood vessels leading to difficulty with blood circulation throughout the body.

• Avoid smoking and other forms of tobacco: Smoking is a major risk factor for Buerger's Disease, so avoiding smoking or stopping if you already do can help prevent it.
• Exercise regularly: Regular physical activities can promote healthy blood circulation.
• Maintain proper diet: Eating foods low in cholesterol and saturated fats may help keep artery walls free from plaque buildup and reduce risk of Buerger's disease.
• Keep stress levels under control: Lowering stress levels helps to maintain healthy lifestyle habits that are beneficial in preventing Buerger’s Disease.
• Practice good hygiene: Washing hands frequently and maintaining personal cleanliness help to prevent the spread of infections caused by bacteria which may lead to inflammation in the arteries and thus increase the risk of Buerger’s Disease.

• Physical Exam:A physical examination can reveal areas of swollen or tender arteries in the legs associated with Buerger’s Disease.
• Doppler Flow Studies:This is a special ultrasound study that measures and records the speed of the blood flow through artery walls, which are narrowed by Buerger’s Disease.
• Angiography:An X-ray dye test that shows narrowed or blocked areas in an artery as well as inflammation sites caused by Buerger’s Disease.
• Tobacco Use History:As there is a strong association with tobacco use and Buerger’s Disease, your doctor will ask about your past and present use of tobacco products.
• Chest X-ray:Buerger's disease can be seen on a chest X-ray. The X-ray may show narrowing of the arteries in the chest that are associated with the disease, as well as narrowing of the veins.
• Blood Tests:Blood tests may be used to help diagnose infection, check your cholesterol level and look for signs of autoimmune diseases associated with Buerger’s Disease such as rheumatoid arthritis.
• Tissue Sampling (skin biopsy):Skin biopsy involves taking skin samples from affected areas for examination under a microscope for inflammation or complications caused by Buerger’s Disease.

• Limb pain and swelling:Buerger's Disease is associated with inflammation of the blood vessels leading to pain and swelling in arms or legs.
• Gangrene:Inflammation of the blood vessels can lead to the death of body tissue, often resulting in limb amputation.
• Skin ulcers:The lack of adequate circulation caused by Buerger's Disease can cause skin ulcers on the toes, feet, and fingertips.
• Heart attack or stroke:Long-term inflammation caused by Buerger's Disease can damage the coronary arteries and put a person at risk for a heart attack or stroke.
• Thrombosis:Veins that are blocked off due to narrowing of the blood vessels can cause clotting, which further restricts circulation and leads to thrombosis.

• Have fresh fruit juices, specifically Giloy juice which helps reduce inflammation.
• Regularly consume herbs like Ashwagandha and Guggul to keep veins strong.
• Include black raisins, holy basil leaves or Tulsi tea and garlic in your diet to improve blood circulation.
• Maintain a healthy lifestyle by making dietary changes, quitting smoking and exercising regularly.

• A low-fat, low-cholesterol diet containing plant foods such as fruits, vegetables, and whole grains.
• Foods with sufficient dietary fiber, including legumes and nuts.
• Fish rich in omega-3 fatty acids as an alternative to red meat and other saturated fats.
• Foods that are high in antioxidants, such as green tea.
• Low sodium foods like lean meats, whole grains, fruits & vegetables.

• Avoid nicotine-containing products, including cigarettes, cigars, and vaping products.
• Cut back on fatty and sugary foods.
• Eliminate processed and smoked meats from your diet.
• Choose whole grains instead of white bread or refined grains like white flour.,
• Limit alcohol intake to no more than one drink per day for women or two per day for men.

• Lifestyle modifications:Lifestyle changes such as exercising more, eating a healthy diet, and avoiding high-risk behaviors like smoking can reduce the risk of further damaging blood vessels.
• Medications:Medications such as cilostazol may also be prescribed to improve blood flow in the legs and reduce inflammation. Other drugs that may be prescribed include pain medications, anticoagulants, etc.
• Endovascular intervention:Using catheters, narrow and blocked arteries can be opened (dilated) or blocked off completely (embolized).
• Sympathectomy:This involves damaging the nerves which cause spasms in the blood vessels.
• Open Surgical Intervention:Involves surgical bypass or ligation of diseased vessels, to restore better blood flow to muscles and limbs in severely affected areas.
• Amputation:In extreme long standing cases amputation may become necessary due to severe tissue damage caused by lack of blood supply for a prolonged period of time.

• A doctor specializing in vascular diseases, such as a vascular surgeon or a cardiologist, should be consulted for Buerger’s Disease.
• The doctor will diagnose the condition by performing physical examination and imaging tests like X-ray, CT scan or MRI scan to assess the degree of vessel blockage.

• Antiplatelet agents:These drugs are used to prevent the formation of blood clots and reduce the risk of stroke, heart attack and other cardiovascular problems. Examples include aspirin, clopidogrel, ticagrelor and prasugrel.
• Anticoagulants:These medications are typically prescribed to decrease inflammation in blood vessels and reduce risk of blood clots. Common anticoagulants include warfarin and different kinds of heparin.
• Vasodilators:These drugs work by widening blood vessels in order to increase blood flow and reduce symptoms such as pain or cramping in arms or legs caused by reduced circulation due to restricted vessels in Buerger’s disease. Examples include nifedipine, nicardipine and isosorbide dinitrate.
• Beta-blockers:These drugs work by blocking certain receptors in the body to help lower blood pressure and reduce chest pain associated with Buerger’s disease. Examples include propranolol, metoprolol tartrate and sotalol hydrochloride.
• Topical medications:Certain types of creams or ointments can be applied directly to affected areas topically for relief from inflammation caused by Buerger’s disease. Examples include lidocaine gel, capsaicin cream and hydrocortisone cream/ointment.

The time it takes to recover from Buerger's Disease varies depending on the individual and the severity of their condition, but typical recovery times can range from a few weeks to several months.

• The results of treatment for Buerger's Disease may not be permanent. Depending on the severity and form of the disease, the individual may experience periods of remission and recurrence, with symptoms fluctuating in intensity over time.
• In some cases, surgery or clot-dissolution treatments may resolve symptoms enough to be considered a cure. However, even in these cases relapses are possible as well.

• Antiplatelet agents:These drugs are used to prevent the formation of blood clots and reduce the risk of stroke, heart attack and other cardiovascular problems. Examples include aspirin, clopidogrel, ticagrelor and prasugrel.
• Anticoagulants:These medications are typically prescribed to decrease inflammation in blood vessels and reduce risk of blood clots. Common anticoagulants include warfarin and different kinds of heparin.
• Vasodilators:These drugs work by widening blood vessels in order to increase blood flow and reduce symptoms such as pain or cramping in arms or legs caused by reduced circulation due to restricted vessels in Buerger’s disease. Examples include nifedipine, nicardipine and isosorbide dinitrate.
• Beta-blockers:These drugs work by blocking certain receptors in the body to help lower blood pressure and reduce chest pain associated with Buerger’s disease. Examples include propranolol, metoprolol tartrate and sotalol hydrochloride.
• Topical medications:Certain types of creams or ointments can be applied directly to affected areas topically for relief from inflammation caused by Buerger’s disease. Examples include lidocaine gel, capsaicin cream and hydrocortisone cream/ointment.

• Treatment for Buerger’s Disease can be expensive in India due to the cost of medical procedures and medications.
• Depending on the extent of treatment, typically costs can range from about 18,000 rupees for nonsurgical procedures to 200,000 rupees or more for multiple surgeries.
• The cost also includes medications, consultations with doctors and other healthcare professionals.

The side effects of Buerger’s disease treatments vary and can depend on the specific treatment being used. Common side-effects may include:

• Dizziness
• Nausea
• Stomach upset
• Skin irritation
• Sleepiness
• Changes in blood pressure
• Heart palpitations
• Headaches.