Buerger’s Disease

Buerger’s disease (thromboangiitis obliterans or TAO) is a rare non-atherosclerotic vascular disease, characterized by a combination of segmental inflammation and thrombosis of medium- and small-sized arteries and veins both in the arms and the legs. The inflammatory process leads to severe ischemic rest pain, non-healing sores, ulceration, and gangrene of fingers and toes. The disease is more common in young males, though its incidence seems to be increasing among women. Buerger’s disease is strongly associated with tobacco abuse in any form, which most probably triggers an autoimmune response. TAO does not fulfill, however, the criteria for a classical autoimmune disease, because no autoantigen has been clearly identified to date in the disease. Various sets of diagnostic criteria have been suggested over the years and the diagnosis requires the elimination of many other diseases. Absolute discontinuation of smoking remains the essential mode of therapy. New therapeutic modalities have been recently studied in small series, all requiring further evaluation in randomized controlled trials.