Buerger's Disease (Thromboangiitis Obliterans)

Buerger's disease, also called thromboangiitis obliterans, is inflammation and clotting that block the small and medium arteries and veins of the hands and feet, leaving the fingers and toes ischemic. It occurs almost exclusively in people who use tobacco, usually men between 20 and 45. The client has cramping in the arch of the foot or the calf with walking, pain at rest, cold or numb fingers and toes, color changes and painful ulcers that can progress to gangrene; Raynaud phenomenon and tender, migrating cords of surface-vein inflammation are common. Unlike atherosclerotic peripheral arterial disease, it strikes younger people, affects the smallest distal vessels and often involves the hands. Complete, permanent stopping of all tobacco and nicotine, including vaping, chewing tobacco and nicotine patches, is the only measure that halts it; about half of clients who keep using lose a finger or toe. Nursing care supports cessation, keeps the hands and feet warm without heating pads, protects them from injury, avoids vasoconstricting medicines such as decongestants, and reports new ulcers or worsening color changes.