Difference between revisions of "Thromboangiitis obliterans"

(Disposition)
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==Background==
 
==Background==
*AKA Thromboangiitis Obliterans
+
*Also known as Thromboangiitis Obliterans
 
+
*Idiopathic inflammatory occlusive disease of the hands and feet (exact pathogenesis unknown)
===Pathophysiology===
+
*Risk factors: Male, tobacco users, Middle Eastern
* Idiopathic inflammatory occlusive disease of the hands and feet
+
**Virtually all affected patients are smokers
**Exact pathogenesis unknown
 
 
 
===Risk Factors===
 
*Male, tobacco, Middle Eastern
 
**Virtually all patients are smokers
 
  
 
==Clinical Features==
 
==Clinical Features==
 
*Red, tender nodules over peripheral arteries
 
*Red, tender nodules over peripheral arteries
**+/- diminished pulses
+
**May have diminished pulses
 
*In-step claudication
 
*In-step claudication
 
*Hand claudication
 
*Hand claudication
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==Differential Diagnosis==
 
==Differential Diagnosis==
*Chronic PAD
+
*Chronic peripheral artery disease
 
**Atherosclerosis Obliterans
 
**Atherosclerosis Obliterans
 
 
*Acute PAD
 
*Acute PAD
 
**Atheroembolism (AKA Blue Toe Syndrome)
 
**Atheroembolism (AKA Blue Toe Syndrome)
 
**Arterial embolism
 
**Arterial embolism
 
**Arterial thrombosis
 
**Arterial thrombosis
 
 
*Vasospastic Disorders
 
*Vasospastic Disorders
 
**Raynaud’s Disease
 
**Raynaud’s Disease
 
**Primary Erythromelalgia
 
**Primary Erythromelalgia
 
 
*Autoimmune
 
*Autoimmune
 
**Scleroderma
 
**Scleroderma
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==Disposition==
 
==Disposition==
*No evidence/threat of tissue loss:
+
*Discharge with vascular follow-up if no evidence/threat of tissue loss
**Outpatient vascular f/u
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*Otherwise admit
*Evidence/threat of tissue loss:
 
**Vascular consult
 
  
 
==See Also==
 
==See Also==
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==External Links==
 
==External Links==
 +
  
 
==References==
 
==References==
 
<references/>
 
<references/>
 +
 +
[[Category:Vascular]]

Revision as of 22:30, 6 February 2017

Background

  • Also known as Thromboangiitis Obliterans
  • Idiopathic inflammatory occlusive disease of the hands and feet (exact pathogenesis unknown)
  • Risk factors: Male, tobacco users, Middle Eastern
    • Virtually all affected patients are smokers

Clinical Features

  • Red, tender nodules over peripheral arteries
    • May have diminished pulses
  • In-step claudication
  • Hand claudication
    • Often bilateral & symmetrical
    • May lead to ulceration

Differential Diagnosis

  • Chronic peripheral artery disease
    • Atherosclerosis Obliterans
  • Acute PAD
    • Atheroembolism (AKA Blue Toe Syndrome)
    • Arterial embolism
    • Arterial thrombosis
  • Vasospastic Disorders
    • Raynaud’s Disease
    • Primary Erythromelalgia
  • Autoimmune
    • Scleroderma
    • SLE

Evaluation

  • Clinical criteria for Dx (noninvasive testing not necessary)
    • History of smoking
    • Onset prior to <50 y/o
    • Absence of atherosclerotic risk factors
    • Upper limb involvement
    • Infrapopliteal arterial occlusive lesions

Management

  • Abstinence from tobacco
  • Early symptoms w/o threatened tissue loss: outpatient vascular
  • Advanced disease: intra-arterial or intravenous PGE1, ASA, Heparin, arterial reconstruction, sympathectomy

Disposition

  • Discharge with vascular follow-up if no evidence/threat of tissue loss
  • Otherwise admit

See Also

External Links

References