The Path to Diagnosis: Confirming Buerger Disease

Because there is no single blood test that can “prove” you have Buerger disease, doctors use a process called diagnosis of exclusion ^[1][2]. This means they must systematically rule out every other possible cause for your symptoms—such as diabetes, high cholesterol, or autoimmune diseases—before confirming it is Buerger disease. To do this, they rely on a specific set of clinical requirements and advanced imaging.

The Shionoya Diagnostic Criteria

Most specialists use the Shionoya criteria to determine if a patient has Buerger disease ^[3][4]. To receive a diagnosis, you typically must meet all five of these clinical benchmarks:

1. Tobacco History: A current or recent history of using tobacco or nicotine products ^[3].
2. Early Onset: The symptoms began before the age of 50 ^[3][4].
3. Specific Blockages: Evidence of arterial blockages below the knee or elbow (infrapopliteal or infrabrachial) ^[3].
4. Upper Limb or Vein Involvement: Signs of the disease in your hands/arms or a history of phlebitis migrans (migrating red lumps in the veins) ^[3].
5. Exclusion of Others: No other major risk factors for atherosclerosis, such as uncontrolled diabetes or very high cholesterol ^[3][5].

Bedside Tests: Allen Test and ABI

Before ordering expensive scans, your doctor may perform simple physical tests:

• Allen Test: Your doctor will press on the arteries in your wrist and ask you to open and close your hand. When they release the pressure, they watch how quickly your palm turns red again. In Buerger disease, this process is often significantly slowed, indicating blockages in the small vessels of the hand ^[6][1].
• ABI (Ankle-Brachial Index): This test compares the blood pressure in your ankle to the blood pressure in your arm. While useful for checking general circulation, it can sometimes be misleading in Buerger disease because the blockages are often located much further down in the toes, where standard pressure cuffs cannot reach ^[7][8].

Imaging: “Corkscrew” Collaterals

The most definitive evidence of Buerger disease often comes from an angiogram—a special X-ray that uses dye to see inside your arteries ^[2].

• Segmental Occlusions: The scan will show “skip lesions,” where a section of an artery is blocked, followed by a healthy section, then another blockage ^[2][9].
• Corkscrew Collaterals: When an artery is blocked, the body tries to grow tiny new vessels to bypass it. In Buerger disease, these vessels have a very distinctive, wiggly appearance known as corkscrew collaterals ^[2][10]. While other diseases can cause collateral growth, this specific “corkscrew” pattern is a hallmark sign of TAO ^[2].

Your Diagnostic Checklist

To ensure your diagnosis is correct, your medical team should have performed the following to rule out other conditions:

• [ ] Blood Sugar & Lipids: To rule out diabetes and high cholesterol (atherosclerosis) ^[1].
• [ ] Autoimmune Panel: Tests like ANA (Antinuclear Antibody) and RF (Rheumatoid Factor) to rule out lupus or scleroderma ^[1].
• [ ] Echocardiogram: An ultrasound of the heart to ensure “traveling” blood clots (emboli) aren’t the cause ^[2][11].
• [ ] Hypercoagulable Screen: Tests to see if your blood has a genetic tendency to clot too easily ^[2].
• [ ] Vascular Imaging: A CTA, MRA, or traditional angiogram to look for the signature “corkscrew” vessels ^[2].