Buerger disease

Buerger disease, also known as thromboangiitis obliterans, is a chronic, non-atherosclerotic, inflammatory, thrombotic arteritis found predominantly in young male smokers.

Clinical presentation

Patients may initially present with nonspecific symptoms such as hand and foot claudication, which eventually progresses to ischaemic ulceration. A biopsy is often necessary to make the diagnosis because the imaging appearance and symptoms overlap with those of atherosclerosis and other connective tissue diseases.

Pathology

Although it more commonly affects medium and small vessels of the lower extremities, upper extremity involvement may also be seen. Venous involvement can be seen in 25% of cases.

Associations

• superficial thrombophlebitis ⁴

Radiographic features

Angiography (DSA)

Characteristic angiographic findings include:

• extensive arterial occlusive disease
• corkscrew collateral vessels
• more than one limb is usually affected
• predominantly the lower limbs
• intervening normal arteries
• sparing of the larger inflow vessels

Corkscrew collateral vessels are not, however, pathognomonic for Buerger disease as they may be seen in patients with connective tissue disease.

Differential diagnosis

Imaging differential considerations include:

• atherosclerosis
• connective tissue diseases
  • systemic lupus erythematosus (SLE)
  • mixed connective tissue disease
  • scleroderma
  • CREST syndrome
  • rheumatoid arthritis