Difference between revisions of "Thromboangiitis obliterans"

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#redirect [[Vascular_disease#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.<ref>{{Cite journal  | last1 = Highlander | first1 = P. | last2 = Southerland | first2 = CC. | last3 = VonHerbulis | first3 = E. | last4 = Gonzalez | first4 = A. | title = Buerger disease (thromboangiitis obliterans): a clinical diagnosis. | journal = Adv Skin Wound Care | volume = 24 | issue = 1 | pages = 15-7 | month = Jan | year = 2011 | doi = 10.1097/01.ASW.0000392923.37852.43 | PMID = 21173586 }}</ref>
*Clinical-radiologic diagnosis.<ref name=pmid20534945/>
 
Typical symptoms/signs - progression:<ref name=pmid22284771/>
*Intermittent claudication -> ulcers -> [[gangrene]] -> [[amputation]].
 
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>
 
===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==
*Afflicts small and medium-sized vessels of the extremities.
*Corkscrew vessels - seen on angiography.<ref name=pmid20534945>{{Cite journal  | last1 = Fujii | first1 = Y. | last2 = Soga | first2 = J. | last3 = Nakamura | first3 = S. | last4 = Hidaka | first4 = T. | last5 = Hata | first5 = T. | last6 = Idei | first6 = N. | last7 = Fujimura | first7 = N. | last8 = Nishioka | first8 = K. | last9 = Chayama | first9 = K. | title = Classification of corkscrew collaterals in thromboangiitis obliterans (Buerger's disease): relationship between corkscrew type and prevalence of ischemic ulcers. | journal = Circ J | volume = 74 | issue = 8 | pages = 1684-8 | month = Aug | year = 2010 | doi =  | PMID = 20534945 }}</ref>
 
==Microscopic==
Features:<ref name=pmid16892557>{{Cite journal  | last1 = Kurata | first1 = A. | last2 = Schulz | first2 = A. | last3 = Franke | first3 = FE. | title = Reappraisal of thromboangiitis obliterans--a pathological contribution. | journal = Verh Dtsch Ges Pathol | volume = 88 | issue =  | pages = 231-6 | month =  | year = 2004 | doi =  | PMID = 16892557 }}</ref>
*Acute inflammation:
** Endarteritis - neutrophils at the internal elastic lamina (IEL).
** Periarteritis - neutrophils around the arteries.
*Luminal narrowing due to thrombi.<ref name=pmid16722538/>
**Organizing thrombi = thickened tunica intima.
**Vessels may be re-canalized.
 
Notes:
* Typically segmental.<ref name=pmid22284771/>
 
DDx:
*[[Peripheral vascular disease]] ([[atherosclerosis]]) - typically lacks the acute inflammation around the IEL and around the vessels.
*[[Vasculitis]] - have [[fibrinoid necrosis]].
 
Images:
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=2008080217555643 Buerger's disease (surgicalpathologyatlas.com)].
 
==Sign out==
<pre>
MIDDLE FINGER DISTAL PHALANX, LEFT, AMPUTATION:
- ENDARTERITIS, PERIARTERITIS, INTRAVASCULAR THROMBI AND GANGRENE CONSISTENT WITH
  THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).
</pre>
 
==See also==
*[[Vascular disease]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Cardiovascular pathology]]

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:

Sign out

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.
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