29th January 2024

Background

Epidemiology 

Most commonly affects adult males with significant history of cigarette smoking (most significant risk factor). Onset is usually before the age of 45 years. Prevalence is up to 20 cases per 100,000 individuals; however, it is more common in Asia and less common among African Americans. 

Aetiology

The exact cause of Buerger’s disease is unknown; however, tobacco use, particularly cigarette smoking, is an overwhelming predisposing factor for disease. It is thought that the disease is triggered by chemicals in tobacco which irritate the lining of blood vessels. 

Pathophysiology 

Thromboangiitis obliterans affects both small and medium-sized arteries and veins. It localises in the distal arteries of the upper and lower extremities.

Inflammation of the tunica intima with neutrophilic infiltration and micro-abscess formation can spread to the tunica media with the internal elastic lamina usually intact. The development of cell-rich, inflammatory thrombi in the lumen occludes the vessel. This is followed by reorganisation of the thrombus and perivascular fibrosis. Contiguous extension of the inflammatory process to the adjacent structures results in the encasement of the artery, vein and nerve in a fibrous sheath.