Buerger's Disease and Secondary Hyperparathyroidism Associated with Chronic Hemodialysis

Abstract

Thromboangiitis obliterans, or Buerger's disease, is an inflammatory vascular occlusive disease of small- and medium-sized vessels which usually occurs in young males and is strongly associated with tobacco use. We report a patient with end-stage renal disease (on chronic hemodialysis), secondary hyperparathyroidism, and a heavy smoking history who developed multiple digital necroses of both hands. He required amputation of multiple digits; histology was consistent with Buerger's disease. Upper extremity arteriograms revealed no evidence of atherosclerosis. We believe this patient's multiple digital necroses were due to Buerger's disease, continued tobacco use, and vascular calcific deposits caused by his secondary hyperparathyroidism.