The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Case Report

Buerger Disease in an Elderly Man

Authors: Hassan M. Ismail, MD, MPH, FACP

Abstract

Buerger disease is characterized by progressive distal extremity ischemia in persons with recent tobacco consumption. Typically, affected persons are young men. There have been case reports of Buerger disease in older men. Almost all of the reported cases were characterized with progressive, severe disease requiring amputation. We report a case of an older man with features of Buerger disease without significant proximal progression despite active smoking. Arteriographic and pathologic studies confirmed the diagnosis.


Key Points


* Buerger disease is a nonatherosclerotic, segmental, inflammatory disease that affects the veins, nerves, and small- and medium-sized arteries of the distal lower and upper extremities.


* Buerger is a disease of young men who consume tobacco. Old age, however, does not rule out the disease.


* If the diagnostic criteria for Buerger disease are met, the diagnosis is confirmed by the typical histopathological and angiographic findings.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Lie JT. The rise and fall and resurgence of thromboangiitis obliterans (Buerger’s disease). Acta Pathol Jpn 1989;39:153–155.
 
2. Lie JT. Thromboangiitis obliterans (Buerger’s disease) in women. Medicine (Baltimore) 1987;66:65–72.
 
3. Olin JW. Thromboangiitis obliterans (Buerger’s disease). N Engl J Med 2000;343:864–869.
 
4. Mills JL, Taylor LM Jr, Porter JM. Buerger’s disease in the modern era. Am J Surg 1987;154:123–129.
 
5. Mills JL, Porter JM. Buerger’s disease (thromboangiitis obliterans). Ann Vasc Surg 1991;5:570–572.
 
6. Papa M, Bass A, Adar R, et al. Autoimmune mechanisms in thromboangiitis obliterans (Buerger’s disease): the role of tobacco antigen and the major histocompatibility complex. Surgery 1992;111:527–531.
 
7. Lie JT. Thromboangiitis obliterans (Buerger’s disease) and smokeless tobacco. Arthritis Rheum1988;31:812–813.
 
8. Grove WJ, Stansby GP. Buerger’s disease and cigarette smoking in Bangladesh. Ann R Coll Surg Engl 1992;74:115–117.
 
9. Papa MZ, Rabi I, Adar R. A point scoring system for the clinical diagnosis of Buerger’s disease. Eur J Vasc Endovasc Surg 1996;11:335–339.
 
10. Mills JL, Porter JM. Buerger’s disease: a review and update. Semin Vasc Surg 1993;6:14–23.
 
11. Shionoya S. Diagnostic criteria of Buerger’s disease. Int J Cardiol 1998;66(Suppl 1):S243–S245.
 
12. Shionoya S. What is Buerger’s disease? World J Surg 1983;7:544–551.
 
13. Du Toit DF, Maritz J, Klompje J, et al. Buerger’s disease: a case report and review of the literature. S Afr Med J 1984;66:701–702.
 
14. Akimoto N, Akutsu H, Tsuchida H, et al. An aged case of peripheral arterial obstructive disease with progressive limb necrosis. Nippon Geka Gakkai Zasshi 1989;90:622–625.
 
15. Donatelli F, Triggiani M, Nascimbene S, et al. Thromboangiitis obliterans of coronary and internal thoracic arteries in a young woman. J Thorac Cardiovasc Surg 1997;113:800–802.
 
16. Lie JT. Visceral intestinal Buerger’s disease. Int J Cardiol 1998;66(Suppl 1):S249–S256.
 
17. Hoppe B, Lu JT, Thistlewaite P, et al. Beyond peripheral arteries in Buerger’s disease: angiographic considerations in thromboangiitis obliterans. Catheter Cardiovasc Interv 2002;57:363–366.
 
18. Kurata A, Nonaka T, Arimura Y, et al. Multiple ulcers with perforation of the small intestine in Buerger’s disease: a case report. Gastroenterology 2003;125:911–916.
 
19. Harten P, Muller-Huelsbeck S, Regensburger D, et al. Multiple organ manifestations in thromboangiitis obliterans (Buerger’s disease): a case report. Angiology 1996;47:419–425.
 
20. Michail PO, Filis KA, Delladetsima JK, et al. Thromboangiitis obliterans (Buerger’s disease) in visceral vessels confirmed by angiographic and histological findings. Eur J Vasc Endovasc Surg 1998;16:445–448.
 
21. Hussein EA, el Dorri A. Intra-arterial streptokinase as adjuvant therapy for complicated Buerger’s disease: early trials. Int Surg 1993;78:54–58.
 
22. Sasajima T, Kubo Y, Inaba M, et al. Role of infrainguinal bypass in Buerger’s disease: an eighteen-year experience. Eur J Vasc Endovasc Surg 1997;13:186–192.
 
23. Lau H, Cheng SW. Buerger’s disease in Hong Kong: a review of 89 cases. Aust N Z J Surg 1997;67:264–269.
 
24. Sayin A, Bozkurt AK, Tuzun H, et al. Surgical treatment of Buerger’s disease: experience with 216 patients. Cardiovasc Surg 1993;1:377–380.
 
25. Fiessinger JN, Schafer M. Trial of iloprost versus aspirin treatment for critical limb ischaemia of thromboangiitis obliterans: the TAO Study. Lancet 1990;335:555–557.