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= | 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><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> | ||
*Less than 45 years old. | *Less than 45 years old. | ||
*Current or recent tobacco use. | *Current or recent tobacco use. | ||
| Line 35: | Line 35: | ||
** 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 - | *Obliteration of the lumen. | ||
**Thrombi. | |||
**Organizing thrombi - thickened tunica intima. | |||
Notes: | Notes: | ||
Revision as of 16:05, 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
Typical symptoms/signs - progression:[3]
- Intermittent claudication -> ulcers -> gangrene -> amputation.
Treatment:
- Stop smoking.[3]
Formal clinical criteria
All of the following - as per Olin:[4][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:[5][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.
- Obliteration of the lumen.
- Thrombi.
- Organizing thrombi - thickened tunica intima.
Notes:
- Typically segmental.[3]
DDx:
- Peripheral vascular disease (atherosclerosis) - typically lacks the acute inflammation around the IEL and around the vessels.
- Vasculitis - have fibrinoid necrosis.
Images:
Sign out
MIDDLE FINGER DISTAL PHALYNX, LEFT, AMPUTATION: - GANGRENE WITH ENDARTERITIS, PERIARTERITIS AND LUMINAL OBLITERATION/NARROWING CONSISTENT WITH THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).
See also
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 3.0 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.
- ↑ 4.0 4.1 Olin, JW. (Sep 2000). "Thromboangiitis obliterans (Buerger's disease).". N Engl J Med 343 (12): 864-9. doi:10.1056/NEJM200009213431207. PMID 10995867.
- ↑ 5.0 5.1 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/.
- ↑ Kurata, A.; Schulz, A.; Franke, FE. (2004). "Reappraisal of thromboangiitis obliterans--a pathological contribution.". Verh Dtsch Ges Pathol 88: 231-6. PMID 16892557.