Thromboangiitis Obliterans or Buerger's Disease

  • Alessandra Bura
  • Julien Auriol
  • Hervé Rousseau
  • Francis Joffre
Part of the Medical Radiology book series (MEDRAD)


Thromboangiitis obliterans is a rare inflammatory vascular disease affecting small- and medium-sized arteries, and superficial veins of superior and inferior limbs. Critical limb ischaemia constitutes the most feared consequence of this disease, often occurring before the age of 40. The diagnosis is difficult in the absence of specific markers or well-identified aetiological factors. The link with tobacco consumption makes discussing the alternative diagnosis of juvenile atheroma imperative. Traditional angiography is still the best diagnostic imaging method for this disease involving the distal arteries. The only proven therapeutic strategy to stop the progression of the disease is tobacco cessation, prostanoids being useful at short term, but less certain at 6 months. Endovascular and surgical treatments are rarely feasible, since very peripheral arteries are involved, and no specific studies are available on these techniques in this context.


Magnetic Resonance Angiography Mixed Connective Tissue Disease Rheumatoid Vasculitis Crest Syndrome Thromboangiitis Obliterans 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adar R, Papa MZ, Halpern Z, Mozes M, Shoshan S, Sofer B, Zinger H, Dayan M, Mozes E (1983) Cellular sensitivity to collagen in thromboangiitis obliterans. N Engl J Med 308:1113–1116PubMedCrossRefGoogle Scholar
  2. Azizi M, Boutouyrie P, Bura-Riviere A, Peyrard S, Laurent S, Fiessinger JN (2010) Thromboangiitis obliterans and endothelial function. Eur J Clin Invest 40:518–526PubMedCrossRefGoogle Scholar
  3. Brodmann M, Renner W, Stark G, Winkler M, Pabst E, Hofmann C, Pilger E (2000) Prothrombotic risk factors in patients with thrombangitis obliterans. Thromb Res 99:483–486PubMedCrossRefGoogle Scholar
  4. Buerger L (1908) Thrombo-angiitis obliterans: a study of the vascular lesions leading to presenile spontaneous gangrene. Am J Med Sci 136:567–580CrossRefGoogle Scholar
  5. Bura A, Boutouyrie P, Peyrard S, Fiessinger J, Laurent S, Azizi M (2007) Lack of endothelial dysfunction in thrombonagiitis obliterans. J Thromb Haemost Suppl.2 P-W-447Google Scholar
  6. Cachovan M (1988) Epidemiologie and geographisches Verteilungsmuster der thromboangiitis obliterans. In: Heidrich H, ed. Thromboangiitis Obliterans Morbos Winiwarter-Buerger. vol 31, Thieme G, Germany p 6Google Scholar
  7. Caramaschi P, Biasi D, Carletto A, Friso S, Girelli D, Arcaro G, Bambara LM (2000) Three cases of Buerger’s disease associated with hyperhomocysteinemia. Clin Exp Rheumatol 18:264–265PubMedGoogle Scholar
  8. Carr ME Jr, Hackney MH, Hines SJ, Heddinger SP, Carr SL, Martin EJ (2002) Enhanced platelet force development despite drug-induced inhibition of platelet aggregation in patients with thromboangiitis obliterans—two case reports. Vasc Endovasc Surg 36:473–480CrossRefGoogle Scholar
  9. Casellas M, Perez A, Cabero L, Segura A, Puig de Morales E, Selva O’Callaghan R (1993) Buerger’s disease and antiphospholipid antibodies in pregnancy. Ann Rheum Dis 52:247–248PubMedCrossRefGoogle Scholar
  10. Chander J, Singh L, Lal P, Jain A, Lal P, Ramteke VK (2004) Retroperitoneoscopic lumbar sympathectomy for Buerger’s disease: a novel technique. JSLS 8:291–296PubMedGoogle Scholar
  11. Choudhury NA, Pietraszek MH, Hachiya T, Baba S, Sakaguchi S, Takada Y, Takada A (1992) Plasminogen activators and plasminogen activator inhibitor 1 before and after venous occlusion of the upper limb in thromboangiitis obliterans (Buerger’s disease). Thromb Res 66:321–329PubMedCrossRefGoogle Scholar
  12. Corelli F (1973) Buerger’s disease: cigarette smoker disease may always be cured by medical therapy alone. Uselessness of operative treatment. J Cardiovasc Surg (Torino) 14:28–36Google Scholar
  13. Czarnacki M, Gacka M, Adamiec R (2004) A role of endothelin 1 in the pathogenesis of thromboangiitis obliterans (initital news). Przegl Lek 61:1346–1350PubMedGoogle Scholar
  14. Dible J (1966) The pathology of limb ischaemia. Oliver and Boyd, Scotland, pp 79–96Google Scholar
  15. Disdier P, Granel B, Serratrice J, Constans J, Michon-Pasturel U, Hachulla E, Conri C, Devulder B, Swiader L, Piquet P, Branchereau A, Jouglard J, Moulin G, Weiller PJ (2001) Cannabis arteritis revisited—ten new case reports. Angiology 52:1–5PubMedGoogle Scholar
  16. Eichhorn J, Sima D, Lindschau C, Turowski A, Schmidt H, Schneider W, Haller H, Luft FC (1998) Antiendothelial cell antibodies in thromboangiitis obliterans. Am J Med Sci 315:17–23PubMedCrossRefGoogle Scholar
  17. Fiessinger JN, Schafer M (1990) Trial of iloprost versus aspirin treatment for critical limb ischaemia of thromboangiitis obliterans. The TAO study. Lancet 335:555–557PubMedCrossRefGoogle Scholar
  18. Giffard RJ, Hines EJ (1951) Complete clinical remission in thromboangiitis obliterans during abstinence from tobacco: report of case. Proc Staff Meet Mayo Clin 26:241–245Google Scholar
  19. Hassoun Z, Lacrosse M, De Ronde T (2001) Intestinal involvement in Buerger’s disease. J Clin Gastroenterol 32:85–89PubMedCrossRefGoogle Scholar
  20. Hooten W, Bruns H, Hays J (1998) Inpatient treatment of severe nicotine dependence in a patient with thromboangiitis obliterans (Buerger’s disease). Mayo Clin Proc 73:529–532PubMedCrossRefGoogle Scholar
  21. Ishikawa K (1976) Annual report of the Buerger’s disease research committee of Ministry of Health and Welfare of Japan. Ministry of Health and Welfare, Japan, pp 3–15 86–97Google Scholar
  22. Isner JM, Baumgartner I, Rauh G, Schainfeld R, Blair R, Manor O, Razvi S, Symes JF (1998) Treatment of thromboangiitis obliterans (Buerger’s disease) by intramuscular gene transfer of vascular endothelial growth factor: preliminary clinical results. J Vasc Surg 28:964–973, discussion 973–965PubMedCrossRefGoogle Scholar
  23. Jacq F.and Fiessinger J. (1997) Thromboangéite oblitérante ou maladie de Buerger. In: Encycl Méd Chir, Angéiologie, vol 19, Elsevier, Paris, pp 1530–1534Google Scholar
  24. Joyce JW (1990) Buerger’s disease (thromboangiitis obliterans). Rheum Dis Clin North Am 16:463–470PubMedGoogle Scholar
  25. Kobayashi M, Ito M, Nakagawa A, Nishikimi N, Nimura Y (1999) Immunohistochemical analysis of arterial wall cellular infiltration in Buerger’s disease (endarteritis obliterans). J Vasc Surg 29:451–458PubMedCrossRefGoogle Scholar
  26. Leu HJ (1975) Early inflammatory changes in thromboangiitis obliterans. Pathol Microbiol (Basel) 43:151–156Google Scholar
  27. Lie JT (1988) Thromboangiitis obliterans (Buerger’s disease) and smokeless tobacco. Arthr Rheum 31:812–813CrossRefGoogle Scholar
  28. Lie JT (1990) Diagnostic histopathology of major systemic and pulmonary vasculitic syndromes. Rheum Dis Clin North Am 16:269–292PubMedGoogle Scholar
  29. Makita S, Nakamura M, Murakami H, Komoda K, Kawazoe K, Hiramori K (1996) Impaired endothelium-dependent vasorelaxation in peripheral vasculature of patients with thromboangiitis obliterans (Buerger’s disease). Circulation 94:II211–II215PubMedGoogle Scholar
  30. Marder VJ, Mellinghoff IK (2000) Cocaine and Buerger disease: is there a pathogenetic association? Arch Intern Med 160:2057–2060PubMedGoogle Scholar
  31. Maslowski L, McBane R, Alexewicz P, Wysokinski WE (2002) Antiphospholipid antibodies in thromboangiitis obliterans. Vasc Med 7:259–264PubMedCrossRefGoogle Scholar
  32. Matsubara T, Mason W, Kashani IA, Kligerman M, Burns JC (1996) Gastrointestinal hemorrhage complicating aspirin therapy in acute Kawasaki disease. J Pediatr 128:701–703PubMedCrossRefGoogle Scholar
  33. Matsushita M, Nishikimi N, Sakurai T, Nimura Y (1998) Decrease in prevalence of Buerger’s disease in Japan. Surgery 124:498–502PubMedCrossRefGoogle Scholar
  34. McLoughlin GA, Helsby CR, Evans CC, Chapman DM (1976) Association of HLA-A9 and HLA-B5 with Buerger’s disease. Br Med J 2:1165–1166PubMedCrossRefGoogle Scholar
  35. Mills JL, Porter JM (1993) Buerger’s disease: a review and update. Semin Vasc Surg 6:14–23PubMedGoogle Scholar
  36. Mills JL, Taylor LM Jr, Porter JM (1987) Buerger’s disease in the modern era. Am J Surg 154:123–129PubMedCrossRefGoogle Scholar
  37. Miyamoto K, Nishigami K, Nagaya N, Akutsu K, Chiku M, Kamei M, Soma T, Miyata S, Higashi M, Tanaka R, Nakatani T, Nonogi H, Takeshita S (2006) Unblinded pilot study of autologous transplantation of bone marrow mononuclear cells in patients with thromboangiitis obliterans. Circulation 114:2679–2684PubMedCrossRefGoogle Scholar
  38. Noel B (2002) Vascular complications of cocaine use. Stroke 33:1747–1748, author reply 1747–1748PubMedCrossRefGoogle Scholar
  39. Olin JW (2000) Thromboangiitis obliterans (Buerger’s disease). N Engl J Med 343:864–869PubMedCrossRefGoogle Scholar
  40. Olin JW (2002) Are anticardiolipin antibodies really important in thromboangiitis obliterans (Buerger’s disease)? Vasc Med 7:257–258PubMedCrossRefGoogle Scholar
  41. Olin J, Lie J (1996) Thromboangiitis obliterans (Buerger’s disease). In: Loscalzo J, Creager MA, Dzau VJ, Vascular medicine, Boston, LittleBrown, pp 1033–1049Google Scholar
  42. Olin JW, Young JR, Graor RA, Ruschhaupt WF, Bartholomew JR (1990) The changing clinical spectrum of thromboangiitis obliterans (Buerger’s disease). Circulation 82:IV3–IV8PubMedGoogle Scholar
  43. Otawa T, Jugi T, Kawano N, Mishima Y, Toyama H (1974) Letter: HL-A antigens in thromboangiitis obliterans. JAMA 230:1128PubMedCrossRefGoogle Scholar
  44. Papa M, Adar R (1992) A critical look at thromboangiitis obliterans (Buerger’s disease). Vasc Surg 5:1–18Google Scholar
  45. Papa MZ, Rabi I, Adar R (1996) A point scoring system for the clinical diagnosis of Buerger’s disease. Eur J Vasc Endovasc Surg 11:335–339PubMedCrossRefGoogle Scholar
  46. Sasajima T, Kubo Y, Inaba M, Goh K, Azuma N (1997) Role of infrainguinal bypass in Buerger’s disease: an eighteen-year experience. Eur J Vasc Endovasc Surg 13:186–192PubMedCrossRefGoogle Scholar
  47. Sasaki S, Sakuma M, Kunihara T, Yasuda K (1999) Current trends in thromboangiitis obliterans (Buerger’s disease) in women. Am J Surg 177:316–320PubMedCrossRefGoogle Scholar
  48. Shionoya S (1980) Diagnostic criteria for Winiwarter-Buerger’s disease. VASA 9:270–276PubMedGoogle Scholar
  49. Shionoya S (1998) Diagnostic criteria of Buerger’s disease. Int J Cardiol 66 (Suppl 1):S243–S245 discussion S247PubMedCrossRefGoogle Scholar
  50. Shionoya S, Leu H. and Lie J. (1995) Buerger’s disease (thromboangiitis obliterans). In: Stehbens WE, Lie JT, Vascular pathology, Medical CH, London, pp 657–678Google Scholar
  51. Smolen JS, Youngchaiyud U, Weidinger P, Kojer M, Endler AT, Mayr WR, Menzel EJ (1978) Autoimmunological aspects of thromboangiitis obliterans (Buerger’s disease). Clin Immunol Immunopathol 11:168–177PubMedCrossRefGoogle Scholar
  52. Szilagyi DE, Derusso FJ, Elliott JP Jr (1964) Thromboangiitis obliterans. Clinico-angiographic correlations. Arch Surg 88:824–835PubMedGoogle Scholar
  53. The European TAO Group Study (1998) Oral iloprost in the treatment of thromboangiitis obliterans (Buerger’s disease): a double-blind, randomised, placebo-controlled trial. Eur J Vasc Endovasc Surg 15:300–307CrossRefGoogle Scholar
  54. Turkbey B, Eldem G, Akpinar E (2009) Mesenteric ischemia in a patient with Buerger’s disease: MDCT findings. JBR-BTR 92:211–212PubMedGoogle Scholar
  55. Von Winiwarter F (1879) Ueber eine eigenthümliche Form von Endarteriitis und Endophlebitis mit Gangrän des Fusses. Arch Klin Chir 23:202–226Google Scholar
  56. Williams G (1969) Recent views on Buerger’s disease. J Clin Pathol 22:573–578PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Alessandra Bura
    • 1
  • Julien Auriol
    • 2
  • Hervé Rousseau
    • 2
  • Francis Joffre
    • 2
  1. 1.Service de Médecine VasculaireCHU RangueilToulouse cedex 9France
  2. 2.Service de RadiologieCHU RangueilToulouse cedex 9France

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