Thromboangiitis obliterans

Thromboangiitis obliterans, abbreviated TAO, is a rare vascular disease characterized by recurrent thrombosis. It primarily afflicts young smokers and is also known as Buerger disease.

It should not be confused with Berger disease (IgA nephropathy).

General

• Strong association with smoking.
• Clinical-radiologic diagnosis.

Typical symptoms/signs - progression:

• Intermittent claudication -> ulcers -> gangrene -> amputation.

Treatment:

• Stop smoking.

Formal clinical criteria

All of the following - as per Olin:

• Less than 45 years old.
• Current or recent tobacco use.
• Sign or symptoms of distal extremity ischemia (claudication, pain at rest, ulcers, gangrene).
• Arteriographic findings consistent with the disease.

Exclusions - with lab tests:

• Autoimmune disease.
• Hypercoagulable state.
• Diabetes mellitus.
• Radiographic findings suggestive of proximal emboli source (echocardiography, arteriography).

Gross

• Afflicts small and medium-sized vessels of the extremities.
• Corkscrew vessels - seen on angiography.

Microscopic

Features:

• Acute inflammation:
  • Endarteritis - neutrophils at the internal elastic lamina (IEL).
  • Periarteritis - neutrophils around the arteries.
• Obliteration of the lumen.
  • Thrombi.
  • Organizing thrombi - thickened tunica intima.

Notes:

• Typically segmental.

DDx:

• Peripheral vascular disease (atherosclerosis) - typically lacks the acute inflammation around the IEL and around the vessels.
• Vasculitis - have fibrinoid necrosis.

Images:

• Buerger's disease (surgicalpathologyatlas.com).

Sign out

MIDDLE FINGER DISTAL PHALYNX, LEFT, AMPUTATION:
- GANGRENE WITH ENDARTERITIS, PERIARTERITIS AND LUMINAL OBLITERATION/NARROWING 
  CONSISTENT WITH THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).

See also

• Vascular disease.