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Buerger’s Disease Patients with Buerger’s disease have loss of hair, trophic nails, and previous toe

amputations.

This patient has positive Buerger’s test. The first part of the Buerger’s test is to

observe pallor of both feet on elevation for 45 degrees (Buerger’s angle) for 1 minute.
Patient experience discomfort and pain in the toes.

• Buerger’s disease (Thromboangiitis obliterans) is a clinical syndrome
characterized by progressive inflammation and segmental thrombosis of
small and medium-sized arteries (and veins) of the upper and lower limbs.

• It is strongly associated with tobacco use, and the disease may persist after
smoking cessation.

• Patients present with rest pain, or tissue loss with ischemic ulcers or
gangrene.

• Diagnostic criteria:

• Age less than 45
• Tobacco use

• Exclusion of other causes of peripheral arterial disease (e.g.
rheumatological causes of arteritis or embolic disease)

• The cornerstone of management is absolute abstinence from tobacco, anti-

platelet therapy, and dressings .

• Lumbar sympathectomy can be considered for symptomatic control.

• Revascularization using endovascular or open means often fail due to poor
distal run-off vessels.

• Digital amputation is common for control of pain or sepsis. If these do not
heal, a major amputation (e.g. forefoot or below-knee amputation) may be

necessary.

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