Investigations
1st investigations to order
blood glucose
Test
Buerger's disease can be excluded in patients with diabetes.
Result
normal
urea
Test
Biochemical evidence of renal failure may suggest the presence of an autoimmune disease.
Result
normal
serum creatinine
Test
Biochemical evidence of renal failure may suggest the presence of an autoimmune disease.
Result
normal
full blood count (FBC) with differential
Test
Excludes a myeloproliferative disease. WBC count may be elevated if infection present.
Result
normal
coagulation screen
Test
Excludes a hypercoagulable state.
Result
normal
thrombophilia screen
Test
Excludes protein C, protein S, and anti-thrombin III deficiencies.
Result
normal
C-reactive protein (CRP)
Test
May be elevated if wet gangrene present.
Result
normal
erythrocyte sedimentation rate (ESR)
Test
May be elevated if wet gangrene present.
Result
normal
arterial Doppler
Test
An arterial Doppler confirms absence of arterial flow.
Result
confirms the absence of infrapopliteal, brachial, or distal pulses
Investigations to consider
anti-nuclear antibody
Test
To rule out other causes of vascular disease, including Raynaud’s phenomenon and systemic lupus erythematosus. Erythrocyte sedimentation rate (ESR), CRP, anti-nuclear antibody, rheumatoid factor, anti-neutrophilic cytoplasmic antibody (ANCA), and complement measurements are usually be normal in people with Buerger’s disease.[28] One study has reported 64% incidence of high anti-nuclear antibody levels with positive rheumatoid factor, and 42% incidence of increased anti-nuclear antibody levels and raised ESR, in patients with Buerger’s disease.[29]
Result
normal
rheumatoid factor
Test
To rule out other causes of vascular disease, including rheumatoid vasculitis. Erythrocyte sedimentation rate (ESR), CRP, anti-nuclear antibody, rheumatoid factor, anti-neutrophilic cytoplasmic antibody (ANCA), and complement measurements are usually normal in people with Buerger’s disease.[28] One study has reported 64% incidence of high anti-nuclear antibody levels with positive rheumatoid factor, and 42% incidence of increased anti-nuclear antibody levels and raised ESR, in patients with Buerger’s disease.[29]
Result
normal
anti-neutrophilic cytoplasmic antibody (ANCA)
Test
To rule out other causes of vascular disease, including granulomatosis with polyangiitis (Wegener’s granulomatosis).
Result
normal
complement levels
Test
To rule out other causes of vascular disease.
Result
normal
anti-centromere antibody
Test
To exclude calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome.
Result
normal
topoisomerase I antibodies (Scl-70)
Test
To exclude systemic sclerosis (scleroderma).
Result
normal
echocardiogram
Test
An echocardiogram looks for evidence of an embolic source. It is used to exclude embolic causes and is normal in Buerger's disease.
Result
normal
arterial duplex
Test
'Corkscrew' collaterals are dilated vasa vasorum of the occluded main artery.
Result
identifies non-atherosclerotic occluded vessels; shows medium and small vessel occlusion, often with 'corkscrew'-shaped collateral vessels (Martorell's sign)
digital subtraction angiography
Test
Demonstrates normal non-atherosclerotic proximal arteries and shows occluded distal small and medium-sized vessels.
'Corkscrew' collaterals are dilated vasa vasorum of the occluded main artery.
Arterial lesions are usually confined to the popliteal, crural, and below-knee vessels in the lower limb, and the forearm vessels in the upper limb.
Result
identifies diseased vessels; classical tortuous 'corkscrew'-shaped collaterals (Martorell's sign) connect unaffected segments of distal vessels
CT angiography
Test
'Corkscrew' collaterals are dilated vasa vasorum of the occluded main artery.
Arterial lesions are usually confined to the popliteal, crural, and below-knee vessels in the lower limb, and the forearm vessels in the upper limb.
CT angiography may be better than digital subtraction angiography for distal vessel disease.
Result
identifies diseased vessels; shows medium and small vessel occlusion, often with 'corkscrew'-shaped collateral vessels (Martorell's sign)
magnetic resonance angiography
Test
'Corkscrew' collaterals are dilated vasa vasorum of the occluded main artery.
Arterial lesions are usually confined to the popliteal, crural, and below-knee vessels in the lower limb, and the forearm vessels in the upper limb.
Magnetic resonance angiography may be better than digital subtraction angiography for distal vessel disease.
Result
identifies diseased vessels; shows medium and small vessel occlusion, often with 'corkscrew'-shaped collateral vessels (Martorell's sign)
tissue biopsy
Test
Tissue biopsy shows evidence pathognomonic of Buerger's disease. While arterial biopsy may aid diagnosis it should be avoided in ischaemic tissue.
Result
highly cellular arterial thrombus; non-disrupted internal elastic lamina; evidence of segmental lesions of collateral vessels
anti-cardiolipin antibodies
Test
Associated with periodontal infections and destruction seen in Buerger's disease.[22]
Result
elevated
Emerging tests
genetic testing
Test
Myeloid differentiation primary-response protein 88 (MyD88) is a gene for which identification may suggest resistance to Buerger's disease, especially in Japanese people.[15]
Result
positive or negative for MyD88 gene resistance polymorphism
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