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).

Contents

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. //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.