Buergers Disease

BUERGERS DISEASE
PRESENTED BY,
MR.JAGDISH SAMBAD
M.Sc.NURSING-MSN
ASSI.PROFESSOR
BALAJI COLLEGE OF NURSING

THROMBOANGITIS OBLITERENS
 Buerger's disease (thromboangiitis obliterans)
is a rare disease of the arteries and veins in the
arms and legs. In Buerger's disease, your blood
vessels become inflamed, swell and can
become blocked with blood clots (thrombi)
 This eventually damages or destroys skin
tissues and may lead to infection and gangrene.
Buerger's disease usually first shows in your
hands and feet and may eventually affect larger
areas of your arms and legs.

It is differentiated from other vessel diseases
by its microscopic appearance. In contrast to
atherosclerosis, Buerger’s disease is
believed to be an autoimmune disease that
results in occlusion of distal vessels.

ALSO CALLED AS
“PRESENILE GANGRENE”

INCIDENCE
 It occurs most often in men between the ages of
20 and 35 years, and it has been reported in all
races and in many areas of the world

ETIOLOGY
 The cause of Buerger’s disease is unknown, but it is
believed to be an autoimmune vasculitis.
 Genetic predisposition
 There is considerable evidence that heavy smoking or
chewing of tobacco is a causative or an aggravating
factor.
 Generally, the lower extremities are affected, but
arteries in the upper extremities or viscera can also be
involved.
 Buerger’s disease is generally bilateral and symmetric
with focal lesions.

RISK FACTORS
 Tobacco use
 Chronic gum disease

PATHOPHYSIOLOGY
 Due to etiological factors
 Acute inflammation and thrombosis of the viens of
hands and feet
 Vasculitis
 Decreased blood supply to skin
 Gangrene formation

CLINICAL MANIFESTATIONS
 Pain
 The patient complains of foot cramps, especially of
the arch ( instep claudication), after exercise.
 A burning pain is aggravated by emotional
disturbances, nicotine and chilling.
 Cold sensitivity of the Raynaud type is found in one
half the patients.
 Digital rest pain is constant, and the characteristics
of the pain do not change between activity and rest.

Physical signs
Includes;
 Intense rubor of the foot
 Absence of the pedal pulse but with normal femoral
and popliteal pulses.
 Radial and ulnar artery pulses are absent or
diminished.
 Various types of paresthesia may develop.
 As the disease progresses, deﬁnite redness or
cyanosis of the part appears when the extremity is in
a dependent position.

• Involvement is generally bilateral, but
color changes may affect only
• one extremity or only certain digits.
• Color changes may progress to
ulceration, and ulceration with gangrene
eventually occurs

ASSESSMENT AND DIAGNOSTIC FINDINGS
 History taking (current or rescent history of
tobacco taking)
 Physical examination (presence of extremity
ischemia.claudication,pain at rest)
 Segmental limb blood pressures ( to
demonstrate the distal location of the
lesions or occlusions)
 Duplex ultrasonography (to document
patency of the proximal vessels and to
visualize the extent of distal disease)
 Contrast angiography (to demonstrate the
diseased portion of the anatomy)
 Distal Plesthysmography

MAIN OBJECTIVES OF MANAGEMENT
 To improve circulation to the extremities
 To prevent the progression of the
disease
 To protect the extremities from trauma
and infection.

MANAGEMENT
 Treatment of ulceration and gangrene is directed toward
minimizing infection and conservative debridement of
necrotic tissue.
 Tobacco use is highly detrimental, and patients are
strongly advised to stop using tobacco completely.
 Vasodilators are rarely prescribed because these
medications blood away from the partially occluded
vessels, making the situation worse.
 Prostaglandins like limaprost are vasodialators which
gives relief in pain.

 A regional sympathetic block or ganglioectomy may be
useful in some instances to produce vasodilatation and
increase blood flow of limb
 Debridement is done for necrotic ulcers.
 In chronic cases lumbar sympathectomy is done to
reduce vasoconstriction and increases blood flow to limb.
 Above knee and below knee amputation is done in rare
cases
 Anti inflammatory drugs like corticosteroids are used for
inflammation and pain
 Bypass can sometimes be helpful

NURSING MANAGEMENT
 If amputation is performed elevating the stump for
the first 24 hours to promote venous return and
minimize edema and the incision is monitored for the
signs of hematoma.
 The patient may experience grief, fear, or anxiety
related to loss of the limb. The patient is encouraged
to discuss his or her feelings. Spiritual advisors and
other health care team members are consulted as
appropriate. Recovery and rehabilitation require
consultation among health care providers.

•The patient is assisted in developing a plan to stop
using tobacco and to manage pain.
•The patient may need to be encouraged to make the
lifestyle changes necessary with a chronic disease,
including modiﬁcations in diet, activity, and hygiene
(skin care).
• The nurse determines whether the patient has a
network of family and friends to assist with activities of
daily living.
•The nurse ensures that the patient has the knowledge
and ability to assess for any postoperative
complications such as infection and decreased blood
ﬂow.

SUMMARY
 Definition
 Etiological factors
 Risk factors
 Patho-physiology
 Clinical manifestation
 Diagnostic evluation
 Medical management
 Nursing management of

THANK
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…………………..

Buergers Disease

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