Thromboangiitis obliterans

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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

Thromboangiitis obliterans of foot
PMC5024906 AJUM-14-18-g002.png
  • 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

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