BUERGER’S DISEASE - A GENERAL OVERVIEW WITH A FOCUS ON NEW THERAPEUTIC APPROACHES

Marlena Kwolek; Alicja Judzińska; Bartosz Piech; Kamila Sobczyńska; Justyna Ignarska; Magda Terbosh; Sabina Kubicz Mzabi; Emilia Trojanowska; Magdalena Dubaj; Julia Osipowska

doi:10.31435/ijitss.2(50).2026.5615

Authors

Marlena Kwolek University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0004-1428-1103
Alicja Judzińska University Clinical Hospital No. 1 in Lublin, Lublin, Poland https://orcid.org/0009-0007-7525-4012
Bartosz Piech University Clinical Hospital No. 1 in Lublin, Lublin, Poland https://orcid.org/0009-0003-4621-5226
Kamila Sobczyńska Stefan Cardinal Wyszyński Provincial Specialist Hospital in Lublin, Lublin, Poland https://orcid.org/0009-0002-0938-1711
Justyna Ignarska University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0009-0340-8240
Magda Terbosh University Clinical Hospital No. 1 in Lublin, Lublin, Poland https://orcid.org/0009-0006-3756-3394
Sabina Kubicz Mzabi University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0008-2788-5538
Emilia Trojanowska SP ZOZ MSWiA in Lublin, Lublin, Poland https://orcid.org/0009-0009-7331-6624
Magdalena Dubaj University Clinical Hospital No. 1 in Lublin, Lublin, Poland https://orcid.org/0009-0005-4429-2679
Julia Osipowska University Clinical Hospital No. 1 in Lublin, Lublin, Poland https://orcid.org/0009-0007-9024-9908

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5615

Keywords:

Buerger's Disease, Thromboangiitis Obliterans, Bosentan, Pentoxifylline, Stempeucel

Abstract

Introduction: Buerger's disease (thromboangiitis obliterans, TAO) is an inflammatory disease affecting small and medium-sized blood vessels, primarily in the extremities. This condition leads to their gradual narrowing and occlusion, resulting in impaired blood flow and tissue ischemia. It most often affects young adults, particularly men. It is strongly associated with tobacco use, which is considered a key risk factor for disease development and progression. Clinical presentation includes limb pain, intermittent claudication, ulceration, and, in advanced cases, tissue necrosis. Although treatment is primarily centered on smoking cessation and symptom relief, recent advances in therapeutic approaches show promising potential.

Purpose: The aim of this review is to discuss Buerger's disease in the context of its pathogenesis, diagnosis, and clinical presentation, and to analyze current therapeutic options.

Methodology: A narrative literature review was conducted in PubMed to identify studies on thromboangiitis obliterans. The search strategy included the keywords "Buerger’s disease" (accounting for variant - "Buerger disease"), "thromboangiitis obliterans" and "treatment". Additionally, reference lists of selected articles were screened to identify further relevant publications. Studies published between 2000 and 2025 and directly related to the topic were included.

Conclusions: Advances in the understanding and management of Buerger’s disease have led to the development of new therapeutic approaches. However, current evidence remains limited, and further well-designed studies are needed to establish optimal treatment strategies and improve patient outcomes.

References

Piazza, G., & Creager, M. A. (2010). Thromboangiitis obliterans. Circulation, 121(16), 1858–1861. https://doi.org/10.1161/CIRCULATIONAHA.110.942383

Yun, H. J., Kim, D. I., Lee, K. H., Lim, S. J., Hwang, W. M., Yun, S. R., & Yoon, S. H. (2015). End stage renal disease caused by thromboangiitis obliterans: A case report. Journal of Medical Case Reports, 9, Article 174. https://doi.org/10.1186/s13256-015-0659-8

Komiya, D., Iwai, K., & Ohno, T. (2023). Efficacy of supervised exercise therapy for intermittent claudication in a case with Buerger’s disease. Cureus, 15(8), Article e43537. https://doi.org/10.7759/cureus.43537

Vijayakumar, A., Tiwari, R., & Kumar Prabhuswamy, V. (2013). Thromboangiitis obliterans (Buerger’s disease): Current practices. International Journal of Inflammation, 2013, Article 156905. https://doi.org/10.1155/2013/156905

Olin, J. W. (2000). Thromboangiitis obliterans (Buerger’s disease). The New England Journal of Medicine, 343(12), 864–869. https://doi.org/10.1056/NEJM200009213431207

Klein-Weigel, P., Volz, T. S., Zange, L., & Richter, J. (2016). Buerger’s disease: Providing integrated care. Journal of Multidisciplinary Healthcare, 9, 511–518. https://doi.org/10.2147/JMDH.S109985

Gupta, P. K., Dutta, S., Kala, S., Nekkanti, M., Desai, S. C., Mahapatra, S. S., Dhar, A., Raju, R., M, R., Behera, A., P, S., Raviraja, N. S., Viswanathan, P., Chandrashekar, M., Thej, C., K V, P., Abraham, J., Boggarapu, H., & Udaykumar, K. (2021). Phase IV postmarketing surveillance study shows continued efficacy and safety of Stempeucel in patients with critical limb ischemia due to Buerger’s disease. Stem Cells Translational Medicine, 10(12), 1602–1613. https://doi.org/10.1002/sctm.21-0197

Jorge, V. C., Araújo, A. C., Noronha, C., Panarra, A., Riso, N., & Vaz Riscado, M. (2011). Buerger’s disease (thromboangiitis obliterans): A diagnostic challenge. BMJ Case Reports, 2011, Article bcr0820114621. https://doi.org/10.1136/bcr.08.2011.4621

Del Conde, I., & Peña, C. (2014). Buerger disease (thromboangiitis obliterans). Techniques in Vascular and Interventional Radiology, 17(4), 234–240. https://doi.org/10.1053/j.tvir.2014.11.003

Harwood, E. A., Blazek, A. J., Radio, S. J., & Deibert, C. M. (2023). Buerger’s disease in the testicle: A case of testicular thromboangiitis obliterans. Cureus, 15(4), Article e37693. https://doi.org/10.7759/cureus.37693

Igari, K., Inoue, Y., & Iwai, T. (2016). The epidemiologic and clinical findings of patients with Buerger disease. Annals of Vascular Surgery, 30, 263–269. https://doi.org/10.1016/j.avsg.2015.07.014

Donas, K. P., Schulte, S., Ktenidis, K., & Horsch, S. (2005). The role of epidural spinal cord stimulation in the treatment of Buerger’s disease. Journal of Vascular Surgery, 41(5), 830–836. https://doi.org/10.1016/j.jvs.2005.01.044

Serefli, D., & Saydam, O. (2022). Endovascular treatment of Buerger’s disease in patients with critical limb ischaemia. Cardiovascular Journal of Africa, 33(5), 254–259. https://doi.org/10.5830/CVJA-2022-018

Arkkila, P. E. (2006). Thromboangiitis obliterans (Buerger’s disease). Orphanet Journal of Rare Diseases, 1, Article 14. https://doi.org/10.1186/1750-1172-1-14

Murali, U., Ahmad, M. A. A., & Najihah, F. (2017). Thromboangitis obliterans involving bilateral upper limb extremities: A rare case report from Malaysia. Journal of Clinical and Diagnostic Research, 11(3), PD06–PD08. https://doi.org/10.7860/JCDR/2017/23807.9507

Bae, M., Chung, S. W., Lee, J., Kim, E., Kang, G., & Jin, M. (2023). Early diagnosis and intervention are needed for a reasonable prognosis of thromboangiitis obliterans. Journal of Chest Surgery, 56(5), 328–335. https://doi.org/10.5090/jcs.22.148

Seebald, J., & Gritters, L. (2015). Thromboangiitis obliterans (Buerger disease). Radiology Case Reports, 10(3), 9–11. https://doi.org/10.1016/j.radcr.2015.06.003

Ribieras, A. J., Ortiz, Y. Y., Liu, Z. J., & Velazquez, O. C. (2022). Therapeutic angiogenesis in Buerger’s disease: Reviewing the treatment landscape. Therapeutic Advances in Rare Disease, 3, Article 26330040211070295. https://doi.org/10.1177/26330040211070295

Rivera-Chavarría, I. J., & Brenes-Gutiérrez, J. D. (2016). Thromboangiitis obliterans (Buerger’s disease). Annals of Medicine and Surgery, 7, 79–82. https://doi.org/10.1016/j.amsu.2016.03.028

Hemsinli, D., Altun, G., Kaplan, S. T., Yildirim, F., & Cebi, G. (2018). Hyperbaric oxygen treatment in thromboangiitis obliterans: A retrospective clinical audit. Diving and Hyperbaric Medicine, 48(1), 31–35. https://doi.org/10.28920/dhm48.1.31-35

Cacione, D. G., Macedo, C. R., do Carmo Novaes, F., & Baptista-Silva, J. C. (2020). Pharmacological treatment for Buerger’s disease. The Cochrane Database of Systematic Reviews, 2020(5), Article CD011033. https://doi.org/10.1002/14651858.CD011033.pub4

Arandjelovic, A., Awad, A., Nicolopoulos, J., & Dolianitis, C. (2025). Buerger’s disease: Successful management of acute cutaneous features and achieving disease remission with pentoxifylline. The Australasian Journal of Dermatology, 66(7), e466–e470. https://doi.org/10.1111/ajd.14593

Narváez, J., García-Gómez, C., Álvarez, L., Santo, P., Aparicio, M., Pascual, M., López de Recalde, M., Borrell, H., & Nolla, J. M. (2016). Efficacy of bosentan in patients with refractory thromboangiitis obliterans (Buerger disease): A case series and review of the literature. Medicine, 95(48), Article e5511. https://doi.org/10.1097/MD.0000000000005511

Hassan, I., Dorjay, K., & Anwar, P. (2014). Pentoxifylline and its applications in dermatology. Indian Dermatology Online Journal, 5(4), 510–516. https://doi.org/10.4103/2229-5178.142528

Sun, S. Y., Li, Y., Gao, Y. Y., & Ran, X. W. (2024). Efficacy and safety of pentoxifylline for venous leg ulcers: An updated meta-analysis. The International Journal of Lower Extremity Wounds, 23(2), 264–274. https://doi.org/10.1177/15347346211050769

Heyboer, M., III, Grant, W. D., Byrne, J., Pons, P., Morgan, M., Iqbal, B., & Wojcik, S. M. (2014). Hyperbaric oxygen for the treatment of nonhealing arterial insufficiency ulcers. Wound Repair and Regeneration, 22(3), 351–355. https://doi.org/10.1111/wrr.12176

Qaja, E., Muco, E., & Hashmi, M. F. (2023). Buerger disease. In StatPearls. StatPearls Publishing.

Cacione, D. G., Moreno, D. H., Nakano, L. C., & Baptista-Silva, J. C. (2017). Surgical sympathectomy for Buerger’s disease. JRSM Open, 8(8), Article 2054270417717666. https://doi.org/10.1177/2054270417717666

Ohta, T., Ishioashi, H., Hosaka, M., & Sugimoto, I. (2004). Clinical and social consequences of Buerger disease. Journal of Vascular Surgery, 39(1), 176–180. https://doi.org/10.1016/j.jvs.2003.08.006