Clinical and radiologic aspects of Buerger's disease

Buerger's disease (BD) is an entity with distinct clinical and pathologic aspects, including etiologic factors, pathogenesis, histology, clinical presentation, course, and prognosis. Comprehensive angiographic studies support the definition of the disease's evolution, provide information about distribution patterns (i.e., bilateral, upper and lower extremities, involvement of trunk arteries), aid in choosing "hot spots" for biopsies, and determine preoperative technical considerations in selection of bypass surgery candidates. In a series of 44 patients with BD, we endeavored to record the frequency of distribution and progression of various stages of disease as well as document the angiographic signs that are commonly accepted as typical of or specific to BD. Characteristic angiographic patterns of the disease are: corkscrew-shaped collateral vessels, cutoff type vascular occlusions, vessels with smooth-lined lumina in non-involved arteries and discontinuous, segmental involvement of affected arteries and veins. Results of pharmacoangiographic functional studies of circulatory disorders appear to cast doubt on the supposed specificity of phenomena such as standing-wave pattern and vasospasm in BD.