Austrian-born U.S. surgeon, pathologist, and urologist, 1879-1943.
ABBR: BD A chronic, recurring, inflammatory, but nonatheromatous vascular occlusive disease, chiefly of the peripheral small and medium-sized arteries (and sometimes veins) of the extremities, causing decreased blood flow to the feet and legs. The disease occasionally affects the hands and causes painful ulceration of the fingertips.
It is diagnosed in approx. 1 in 8000 adults. The disease is seen most commonly in males 20 to 40 who smoke cigarettes or chew tobacco.
Tobacco use is a key element in Buerger disease. Some evidence links Buerger disease with periodontal infection.
SYMPTOMS AND SIGNS
Symptoms include paresthesias of the foot, easy fatigability, and cramps in the foot and leg. In patients with severely limited blood flow to the legs, skin ulceration or moist gangrene of the extremities may develop.
Buerger disease is diagnosed in people with ischemic limb symptoms. The patient should not have other known causes for ischemia of the limbs, such as diabetes mellitus, embolic occlusion of blood vessels, or autoimmune disease.
Absolute, permanent abstinence from tobacco in all forms is crucial. The patient should avoid excessive use of the affected limb, exposure to extremes of temperature, use of drugs that diminish the blood supply to the extremities, trauma, and fungal infections. Aspirin and vasodilators may be prescribed. If gangrene, pain, or ulceration is present, complete bedrest is advised with a padded foot-board or bed cradle to prevent pressure on the extremities; if these are absent, the patient should walk at a comfortable pace for 30 min twice daily. For arterial spasm, blocking of the sympathetic nervous system by injection of various drugs or by sympathectomy may be done. Amputation is sometimes needed to remove infarcted tissue.
The history should document occurrences of painful, intermittent claudication of the instep, calf, or thigh (the claudication is aggravated by exercise and relieved by rest); the patient's walking ability (distance, time, and rest required); the patient's foot response to exposure to cold temperatures (initially cold, numb, and cyanotic; later reddened, hot, and tingling); and any involvement of the hands, such as digital ischemia, trophic nail changes, painful fingertip ulcerations, or gangrene. Peripheral pulses are palpated, and absent or diminished radial, ulnar, or tibial pulses documented. Feet and legs are inspected for superficial vein thrombophlebitis, muscle atrophy, peripheral ulcerations, and gangrene, which occur late in the disease. Soft padding is used to protect the feet, which are washed gently with a mild soap and tepid water, rinsed thoroughly, and patted dry with a soft towel. The patient is instructed in this daily care routine and advised to inspect tissues for injury such as cuts, abrasions, and signs of skin breakdown (redness or soreness) and to report all injuries to the health care provider for treatment. He or she is also advised to avoid wearing tight or restrictive clothing, sitting or standing in one position for long periods, and walking barefoot; the patient should also wear carefully fitted shoes and cotton or woolen stockings; but the stockings should not be so tight as to hinder venous return from the legs. The patient should obtain medical care following any local trauma. Extremities must be protected from extremes of temperature, esp. cold. The patient is taught the Buerger postural exercises if prescribed and is cautioned to avoid use of over-the-counter drugs without the attending health care provider's approval. The patient who smokes is referred to a smoking cessation program, but nicotine patch therapy should not be prescribed because of the patient's associated hypersensitivity to nicotine. For the patient with ulcers and gangrene, bedrest is prescribed; a padded footboard or cradle is used to prevent pressure from bed linens. If hospitalization is required for treatment of ulcers or gangrene, or if amputation is required, rehabilitative needs are considered, esp. regarding changes in body image, and the patient is referred for physical and occupational therapy and for social services as appropriate.
SYN: SEE: thromboangiitis obliterans
Buerger postural exercise
An exercise used for circulatory disturbances of the extremities.
SYN: SEE: Buerger-Allen exercise
A noninvasive bedside test to assess the adequacy of arterial blood flow into the legs. While the patient is lying flat on his or her back, both legs are elevated to an angle of 45°. Loss of the normal perfused color of either leg suggests that its arterial blood flow is compromised becausea normal artery can pump blood against gravity without difficulty.
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