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Given a Helping Hand: Emergency Surgery for Buerger's Disease

In November 2007, Christopher Manno began noticing that most of the fingers in his left hand were alternately turning white and cool and would only come back to normal by pinching and massaging them. Despite several diagnostic tests and a change of medication to help circulation, Mr. Manno’s condition worsened. By January 2008, three of his fingers were ice cold and beginning to take on a bluish hue. “Within just a few days thereafter,” recalls Mr. Manno, “they became almost purple.” His local rheumatologist insisted that he immediately, that same day, Wednesday, January 9, 2008, see Dr. Robert Spiera, a rheumatological specialist at Hospital for Special Surgery.

“That afternoon I saw Dr. Spiera and he was quite alarmed,” says Mr. Manno. “He arranged for me to have an emergency appointment that evening with Dr. Robert Hotchkiss, a hand surgeon of great repute. Dr. Spiera knew he could deal with such an aggressive symptom.”

What Dr. Spiera had recognized in Mr. Manno’s symptoms was an uncommon vascular condition known as Buerger’s disease—a difficult disorder to diagnose that involves inflammation and clotting of arteries and veins of the hands and feet resulting in insufficient blood flow. The disease causes pain in the affected areas, and ulcerations and gangrene are common complications, often resulting in the need for amputation of the involved extremity. As in the case of Mr. Manno, patients often describe the Raynaud’s phenomenon of sensitivity of the hands and fingers to cold.

Dr. Hotchkiss took one look at Mr. Manno’s hand and, with crucial input about diagnostic imaging needs from Hollis G. Potter, MD, Chief, Magnetic Resonance Imaging, and radiologist Douglas N. Mintz, MD, he had Mr. Manno undergo both an MRI and an MRA (magnetic resonance angiography).

“Based on the results from those and other tests, he told me he wanted to operate Friday morning or I would most definitely lose my fingers if not my entire hand to amputation,” says Mr. Manno. “At this point, I put myself entirely in his trust.”

“Mr. Manno was about to lose his hand,” says Dr. Hotchkiss. “He had clotted the essential arterial supply from his wrist to all of his fingers and was facing amputation. Rob Spiera recognized the problem and sent him over to me. I still remember the call. He said ‘can you see this guy today?’At the time of surgery, he had no blood flow to his hand. We essentially replaced the entire arterial supply to his left hand and digits using bypass vein grafts from his forearm. At the end of the procedure, he had almost 100 percent flow—a striking improvement. Because Dr. Spiera knew the gravity of the problem and acted immediately, we were able to save the hand.”

Says Mr. Manno, “If I had gone to any other doctor there’s a very good chance that I wouldn’t have a hand right now. It was deemed to be a miraculously successful surgery performed by one of the few people in the country who could do this kind of work.”

Given a Helping Hand: Emergency Surgery for Buerger's Disease