Thromboangiitis obliterans

Background

• AKA Thromboangiitis Obliterans

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

• 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

See Also

• Peripheral artery disease