Buerger's Syndrome

Abstract

All cases diagnosed as Buerger's disease at The Mount Sinai Hospital from 1933-1963 have been reviewed. A large majority were found to have well- known vascular problems other than what we now consider as Buerger's disease. Only two specimens from 33 amputations had the characteristic histologic findings that Buerger described. It is suggested that the terminology Buerger's disease be replaced by Buerger's syndrome. In 1908, while at The Mount Sinai Hospital, Dr. Leo Buerger described a clinical entity with its histologic counterpart that soon became known as "Buerger's disease."1 The clinical picture was essentially that of arterial insufficiency, mainly in the lower extremities, in a young, Jewish, adult male who smoked. It was frequently associated with a migrating thrombophlebitis. The histologic picture was not as clearly defined but was stated to differ from arteriosclerosis in that (1) normal vessel was found proximal and distal to the lesion, (2) canalization of the occlusive lesion occurred, (3) capillary ingrowth was present in the media, and (4) there was an absence of elastic tissue in the organizing process. It should be noted that most of Buerger's specimens consisted of veins removed during an episode of acute thrombophlebitis. He specifically stated that only in the early stages of the disease, when phlebitis was the main finding, could the lesion be separated from the various stages of arteriosclerosis. In recent years, doubt has been cast on the existence of the clinical or pathological picture described by Buerger.2 Accordingly, it was thought advisable to review the case records and pathologic specimens of patients discharged from The Mount Sinai Hospital with the diagnosis of Buerger's disease over a recent 30-year period. This study is thought to be especially germane, since the bulk of Dr. Buerger's patients were treated at The Mount Sinai Hospital.