Buerger's Disease: Histology and Pathogenesis

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Abstract
Arterial segments of 113 cases of Buerger''s syndrome, including 15 cases with fresh occlusive thrombi, were examined histologically. Intimal fibrous thickening seemed to be the important initial lesion preceding occlusive thrombosis. This lesion, plus disruption and reduplication of the internal elastic lamina and small calcified foci in the inner layer of the media, suggest that the vascular wall is affected by some sort of mechanical injury. The clinical and geographical distribution of Buerger''s syndrome may support this concept. The decreased fibrinolytic activity of the thickened intima of the proximal segment of the occluded artery could contribute to the delay of thrombolysis and to the evolution of occlusive thrombosis. The inflammatory reaction in the occluded segments may be the result of thrombosis. This disease is considered as a primary peripheral thrombosis. A local factor, such as mechanical injury to the vascular wall, may play an important role in the initial development of the arterial disease, and in some cases hypersensitivity reaction may contribute to it.

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