Buerger's Disease Nursing Management & Interventions

Buerger's disease is tightly tied to tobacco, so the single most important thing you teach is that the patient has to quit completely. Nothing else works while they keep smoking.

Definition

Buerger's disease (thromboangiitis obliterans) is a recurring inflammation of the intermediate and small arteries and veins of the lower and upper extremities.

Description

It produces thrombus formation and segmental occlusion of the vessels, and its microscopic appearance separates it from other vessel diseases. Buerger's disease occurs most often in men between 20 and 35 years of age and has been reported across all races worldwide. Heavy smoking or tobacco chewing is a clear causative or aggravating factor.

Clinical Manifestations

Pain is the standout symptom, generally bilateral and symmetric with focal lesions. Patients report cramps in the feet, particularly the arches, after exercise (instep claudication) that ease with rest. Early on, burning pain is aggravated by emotional disturbances, nicotine, or chilling, along with digital rest pain (fingers or toes) and coldness or cold sensitivity. Color changes (rubor) of the feet progress to cyanosis (in one extremity or certain digits) when the extremity is dependent. Various paresthesias develop, and radial and ulnar pulses are absent or diminished when the upper extremities are involved. Eventually ulceration and gangrene set in.

Assessment and Diagnostic Methods

Segmental limb blood pressures, duplex ultrasonography, and contrast angiography identify the occlusions.

Medical Management

The objectives are to improve circulation to the extremities, halt progression, and protect the extremities from trauma and infection.

Treatment includes:

• Completely stopping all tobacco use.
• Regional sympathetic block or ganglionectomy to produce vasodilation and increase blood flow.
• Conservative debridement of necrotic tissue for ulceration and gangrene.
• Amputation when gangrene of a toe develops, usually below-knee and occasionally above-knee. Indications are worsening gangrene (especially if moist), severe rest pain, or severe sepsis.
• Vasodilators are rarely prescribed, since they dilate only healthy vessels.