Buerger disease, also known as thromboangiitis obliterans, is a chronic, non-atherosclerotic, inflammatory, thrombotic arteritis found predominantly in young male smokers.
Patients may initially present with nonspecific symptoms such as hand and foot claudication, which eventually progresses to ischemic 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.
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.
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.
Imaging differential considerations include:
- 1. Stepansky F, Hecht EM, Rivera R et-al. Dynamic MR angiography of upper extremity vascular disease: pictorial review. Radiographics. 28 (1): e28. doi:10.1148/radiol.e28 - Pubmed citation
- 2. Dimmick SJ, Goh AC, Cauzza E et-al. Imaging appearances of Buerger's disease complications in the upper and lower limbs. Clin Radiol. 2012;67 (12): 1207-11. doi:10.1016/j.crad.2012.04.005 - Pubmed citation
- 3. Aqel MB, Olin JW. Thromboangiitis obliterans (Buerger's disease). Vasc Med. 1998;2 (1): 61-6. Pubmed citation
- 4. Blättler W, Schwarzenbach B, Largiadèr J. Superficial vein thrombophlebitis-serious concern or much ado about little?. VASA. 2008;37 (1): 31-8. doi:10.1024/0301-15220.127.116.11 - Pubmed citation