Thromboangiitis obliterans

Revision as of 16:01, 6 February 2017 by Alberina (talk | contribs) (Differential Diagnosis)

Background

  • AKA Thromboangiitis Obliterates

Pathophysiology

  • Idiopathic inflammatory occlusive disease of the hands and feet
    • Exact pathogenesis unknown

Risk Factors

  • Male, tobacco, Middle Eastern
    • Virtually all patients are smokers

Clinical Features

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

Differential Diagnosis

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

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

See Also

External Links

References