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.

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. //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.