Difference between revisions of "Thromboangiitis obliterans"

(Differential Diagnosis)
(Differential Diagnosis)
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*Chronic [[peripheral artery disease]]
 
*Chronic [[peripheral artery disease]]
 
**Atherosclerosis Obliterans
 
**Atherosclerosis Obliterans
*Acute PAD
+
*Acute [[peripheral artery disease]]
 
**Atheroembolism (AKA Blue Toe Syndrome)
 
**Atheroembolism (AKA Blue Toe Syndrome)
 
**Arterial embolism
 
**Arterial embolism

Revision as of 13:26, 14 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 and symmetrical
    • May lead to ulceration

Differential Diagnosis

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