Difference between revisions of "Thromboangiitis obliterans"

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*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 criteria===
===Formal clinical criteria===
All of the following:<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><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>
====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.
*Less than 45 years old.
*Current or recent tobacco use.
*Current or recent tobacco use.
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*Arteriographic findings consistent with the disease.
*Arteriographic findings consistent with the disease.


Exclusions - with lab tests:<ref name=pmid16722538/><ref name=pmid10995867/>
Exclusions - with lab tests:<ref name=pmid16722538/>
*Autoimmune disease.  
*Autoimmune disease.  
*Hypercoagulable state.
*Hypercoagulable state.
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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.
*Obliteration of the lumen - intimal thickening.
*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 PHALYNX, LEFT, AMPUTATION:
MIDDLE FINGER DISTAL PHALANX, LEFT, AMPUTATION:
- GANGRENE WITH ENDARTERITIS, PERIARTERITIS AND LUMINAL OBLITERATION/NARROWING
- ENDARTERITIS, PERIARTERITIS, INTRAVASCULAR THROMBI AND GANGRENE CONSISTENT WITH
   CONSISTENT WITH THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).
   THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).
</pre>
</pre>



Latest revision as of 16:24, 16 July 2013

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.[1]
  • Clinical-radiologic diagnosis.[2]

Typical symptoms/signs - progression:[3]

Treatment:

  • Stop smoking.[3]

Formal clinical criteria

Simple

All of the following - as per Shionoya:[4]

  • 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:[5]

  • 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:[4]

  • 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.[2]

Microscopic

Features:[6]

  • Acute inflammation:
    • Endarteritis - neutrophils at the internal elastic lamina (IEL).
    • Periarteritis - neutrophils around the arteries.
  • Luminal narrowing due to thrombi.[4]
    • Organizing thrombi = thickened tunica intima.
    • Vessels may be re-canalized.

Notes:

  • Typically segmental.[3]

DDx:

Images:

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MIDDLE FINGER DISTAL PHALANX, LEFT, AMPUTATION:
- ENDARTERITIS, PERIARTERITIS, INTRAVASCULAR THROMBI AND GANGRENE CONSISTENT WITH 
  THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).

See also

References

  1. Highlander, P.; Southerland, CC.; VonHerbulis, E.; Gonzalez, A. (Jan 2011). "Buerger disease (thromboangiitis obliterans): a clinical diagnosis.". Adv Skin Wound Care 24 (1): 15-7. doi:10.1097/01.ASW.0000392923.37852.43. PMID 21173586.
  2. 2.0 2.1 Fujii, Y.; Soga, J.; Nakamura, S.; Hidaka, T.; Hata, T.; Idei, N.; Fujimura, N.; Nishioka, K. et al. (Aug 2010). "Classification of corkscrew collaterals in thromboangiitis obliterans (Buerger's disease): relationship between corkscrew type and prevalence of ischemic ulcers.". Circ J 74 (8): 1684-8. PMID 20534945.
  3. 3.0 3.1 3.2 Dargon, PT.; Landry, GJ. (Aug 2012). "Buerger's disease.". Ann Vasc Surg 26 (6): 871-80. doi:10.1016/j.avsg.2011.11.005. PMID 22284771.
  4. 4.0 4.1 4.2 Arkkila, PE. (2006). "Thromboangiitis obliterans (Buerger's disease).". Orphanet J Rare Dis 1: 14. doi:10.1186/1750-1172-1-14. PMC 1523324. PMID 16722538. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1523324/.
  5. Olin, JW. (Sep 2000). "Thromboangiitis obliterans (Buerger's disease).". N Engl J Med 343 (12): 864-9. doi:10.1056/NEJM200009213431207. PMID 10995867.
  6. Kurata, A.; Schulz, A.; Franke, FE. (2004). "Reappraisal of thromboangiitis obliterans--a pathological contribution.". Verh Dtsch Ges Pathol 88: 231-6. PMID 16892557.