Buerger’s disease

Buerger’s disease, also known as thromboangiitis obliterans, causes your small blood vessels to become inflamed and narrowed, which can lead to blood clots that reduce or block blood flow in your hands and feet. The disease can result in ulcers forming on your fingers or toes and may eventually lead to tissue death (gangrene). This disease affects people who use tobacco, including smokers and people who vape. Quitting tobacco is key to treatment, and medications or surgery may improve blood flow.

This is a rare disease that can have serious complications, making it important to seek specialized care. At Penn Medicine, our experts are trained in identifying Buerger’s disease and providing treatments to relieve your symptoms. Your care is overseen by a team of specialists that may include rheumatologists, vascular specialists, and other providers. We also support you as you quit using tobacco through our Stop Smoking Program.

Symptoms of Buerger’s disease begin in your hands and feet but can progress to your arms and legs. Early signs of Buerger’s disease include:

• Burning and tingling in your fingers or toes
• Pain in your arms or legs at rest, or in your leg, foot, or ankle when walking
• Changes in skin color or texture
• Fingers or toes that turn white or blue in the cold, known as Raynaud’s syndrome

Over time, your symptoms may progress to:

• Muscle cramps
• Numbness in your hands or feet
• Open sores on your fingers or toes
• Gangrene, which turns your fingers or toes black or blue and causes numbness and a foul smell

In rare cases, Buerger’s disease can lead to a transient ischemic attack, stroke, heart attack, or other complications.

Buerger’s disease occurs in people who are heavy tobacco users, including those who smoke cigarettes or cigars, vape, or chew tobacco. Doctors think chemicals in tobacco damage the lining of your blood vessels. Genetics and your immune system might play a role, too. Buerger’s disease causes an autoimmune reaction in your body, which means it triggers your immune system to damage healthy tissue.

The disease is more likely to occur in people assigned male at birth and who are under age 45. It’s also more common in parts of the world where smoking is common, including the Mediterranean, Asia, and the Middle East. Other risk factors include having chronic gum disease or atherosclerosis.

Quitting smoking and stopping the use of all tobacco products is the cornerstone of Buerger’s disease treatment. Just smoking one cigarette a day can worsen the disease, but quitting can put the disease into remission and stop your symptoms. Talk to your health care provider about the best way to quit smoking. Don’t use nicotine replacement products because they can further damage your blood vessels. As marijuana has also been associated with Buerger’s disease, it is recommended to avoid marijuana products as well. Also, avoid being around other people who are smoking.

Your doctor might also prescribe medicines to improve blood flow, reduce inflammation, prevent blood clots, and treat open sores and pain. Compression therapy, which involves wearing a sleeve that fills with air, or surgery can also help move blood through your vessels. If the disease leads to gangrene, you’ll need to have dead tissue removed, which might involve amputating a hand or foot.

You can prevent Buerger’s disease by not using any tobacco products, including nicotine patches. If you already use these products, there are programs that can help you quit.

It takes a skilled team of specialists to diagnose Buerger’s disease. Experts from a variety of disciplines work together at Penn Medicine to evaluate your condition and provide treatment for inflamed blood vessels, including specialists in rheumatology and vascular medicine.

Through our smoking treatment program, we personalize your approach to quitting tobacco in a positive and supportive environment. We’re here to give you the tools you need to relieve your symptoms and stop the disease from getting worse.