Thromboangiitis obliterans: Difference between revisions
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==Background== | ==Background== | ||
*Also known as | *Also known as "Buerger's disease" | ||
*Idiopathic inflammatory occlusive disease of the hands and feet (exact pathogenesis unknown) | *Idiopathic inflammatory occlusive disease of the hands and feet (exact pathogenesis unknown) | ||
===Risk factors=== | |||
*Tobacco use | |||
**Virtually all affected patients are smokers | **Virtually all affected patients are smokers | ||
*Male | |||
*Middle Eastern | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:PMC3371931 ircmj-13-420-g001.png|thumb|Thromboangiitis obliterans of foot]] | |||
[[File:PMC5024906 AJUM-14-18-g002.png|thumb]] | |||
*Red, tender nodules over peripheral arteries | *Red, tender nodules over peripheral arteries | ||
**May have diminished pulses | **May have diminished pulses | ||
| Line 12: | Line 18: | ||
**Often bilateral and symmetrical | **Often bilateral and symmetrical | ||
**May lead to ulceration | **May lead to ulceration | ||
*Raynaud phenomenon | |||
*Gangrene and autoamputation of digits in severe disease | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Blue digit DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*Clinical criteria for | *Clinical criteria for diagnosis (noninvasive testing not necessary) | ||
**History of smoking | **History of smoking | ||
**Onset prior to <50 | **Onset prior to <50 years old | ||
**Absence of atherosclerotic risk factors | **Absence of atherosclerotic risk factors | ||
**Upper limb involvement | **Upper limb involvement | ||
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==Management== | ==Management== | ||
*Abstinence from tobacco | *Abstinence from tobacco | ||
*Early symptoms | *Early symptoms with out threatened tissue loss: outpatient vascular | ||
*Advanced disease: intra-arterial or intravenous PGE1, ASA, Heparin, arterial reconstruction, sympathectomy | *Advanced disease: intra-arterial or intravenous PGE1, [[ASA]], [[Heparin]], arterial reconstruction, sympathectomy | ||
==Disposition== | ==Disposition== | ||
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==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
==Video== | |||
{{#widget:YouTube|id=daB4UWA7RXk}} | |||
[[Category:Vascular]] | [[Category:Vascular]] | ||
Revision as of 20:13, 19 March 2019
Background
- Also known as "Buerger's disease"
- Idiopathic inflammatory occlusive disease of the hands and feet (exact pathogenesis unknown)
Risk factors
- Tobacco use
- Virtually all affected patients are smokers
- Male
- Middle Eastern
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
- Raynaud phenomenon
- Gangrene and autoamputation of digits in severe disease
Differential Diagnosis
Blue Digit
- Acute arterial ischemia
- Atheroembolism (AKA Blue Toe Syndrome)
- Arterial embolism
- Arterial thrombosis
- Vasospastic Disorders
- Raynaud’s disease
- Primary erythromelalgia
- Autoimmune
- Idiopathic
- Thromboangiitis obliterans (Buerger's disease)
- Chronic peripheral artery disease
- Atherosclerosis obliterans
Evaluation
- Clinical criteria for diagnosis (noninvasive testing not necessary)
- History of smoking
- Onset prior to <50 years old
- Absence of atherosclerotic risk factors
- Upper limb involvement
- Infrapopliteal arterial occlusive lesions
Management
- Abstinence from tobacco
- Early symptoms with out 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
Video
{{#widget:YouTube|id=daB4UWA7RXk}}