Review Question - QID 4486

The clinical description and photograph are most consistent with a diagnosis of Buerger's disease, or thromboangiitis obliterans. Arteriography is the best method for the diagnosis of this condition.

Buerger's disease is an inflammatory occlusive disorder of small and medium-sized vessels of the digits most frequently occurring in male smokers. The condition may mimic other autoimmune and vascular diseases. If the diagnosis is uncertain, an arteriogram is the study of choice. The only treatment that has been found to reduce the risk of amputation is the cessation of smoking.

Phillips et al. review the vascular conditions of the upper extremity. They discuss that patients with Buerger's disease present with rest pain, claudication, and ulceration, and that cessation of smoking decreases disease progression and the incidence of amputation.

Figure A shows the classic clinical appearance of a patient with Buerger's disease. Illustration A shows an arteriogram with "corkscrew" arteries that result from vascular destruction. In the appropriate clinical setting, this finding is diagnostic of Buerger's disease.

Incorrect Answers:
Answer 1: Treatment has not been shown to halt the progression of Buerger's disease.
Answer 3: Prophylactic amputation of uninvolved digits has not been described for the treatment of Buerger's disease.
Answer 4: Buerger's disease is frequently painful.
Answer 5: Buerger's disease involves distal vessels first and proximal vessels last.