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Difference between revisions of "Thromboangiitis obliterans"
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'''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'''. | '''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== | ==General== | ||
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Treatment: | Treatment: | ||
*Stop smoking.<ref name=pmid22284771>{{Cite journal | last1 = Dargon | first1 = PT. | last2 = Landry | first2 = GJ. | title = Buerger's disease. | journal = Ann Vasc Surg | volume = 26 | issue = 6 | pages = 871-80 | month = Aug | year = 2012 | doi = 10.1016/j.avsg.2011.11.005 | PMID = 22284771 }}</ref> | *Stop smoking.<ref name=pmid22284771>{{Cite journal | last1 = Dargon | first1 = PT. | last2 = Landry | first2 = GJ. | title = Buerger's disease. | journal = Ann Vasc Surg | volume = 26 | issue = 6 | pages = 871-80 | month = Aug | year = 2012 | doi = 10.1016/j.avsg.2011.11.005 | PMID = 22284771 }}</ref> | ||
===Formal clinical criteria=== | |||
====Simple==== | |||
All of the following - as per ''Shionoya'':<ref name=pmid16722538>{{Cite journal | last1 = Arkkila | first1 = PE. | title = Thromboangiitis obliterans (Buerger's disease). | journal = Orphanet J Rare Dis | volume = 1 | issue = | pages = 14 | month = | year = 2006 | doi = 10.1186/1750-1172-1-14 | PMID = 16722538 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1523324/ | PMC = 1523324 }}</ref> | |||
*Smoking. | |||
**No other atherosclerosis risk factors. | |||
*Onset < 50 years old. | |||
*Infrapopliteal arterial occlusions. | |||
*Arm involvement ''or'' phlebitis migrans; | |||
====Complicated==== | |||
All of the following - as per ''Olin'':<ref name=pmid10995867>{{Cite journal | last1 = Olin | first1 = JW. | title = Thromboangiitis obliterans (Buerger's disease). | journal = N Engl J Med | volume = 343 | issue = 12 | pages = 864-9 | month = Sep | year = 2000 | doi = 10.1056/NEJM200009213431207 | PMID = 10995867 | URL = http://www.nejm.org/doi/full/10.1056/NEJM200009213431207 }}</ref> | |||
*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:<ref name=pmid16722538/> | |||
*Autoimmune disease. | |||
*Hypercoagulable state. | |||
*[[Diabetes mellitus]]. | |||
*Radiographic findings suggestive of proximal emboli source (echocardiography, arteriography). | |||
==Gross== | ==Gross== | ||
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** Endarteritis - neutrophils at the internal elastic lamina (IEL). | ** Endarteritis - neutrophils at the internal elastic lamina (IEL). | ||
** Periarteritis - neutrophils around the arteries. | ** Periarteritis - neutrophils around the arteries. | ||
* | *Luminal narrowing due to thrombi.<ref name=pmid16722538/> | ||
**Organizing thrombi = thickened tunica intima. | |||
**Vessels may be re-canalized. | |||
Notes: | Notes: | ||
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==Sign out== | ==Sign out== | ||
<pre> | <pre> | ||
MIDDLE FINGER DISTAL | MIDDLE FINGER DISTAL PHALANX, LEFT, AMPUTATION: | ||
- | - ENDARTERITIS, PERIARTERITIS, INTRAVASCULAR THROMBI AND GANGRENE CONSISTENT WITH | ||
THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE). | |||
</pre> | </pre> | ||