Diferencia entre revisiones de «Thromboangiitis obliterans»
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==Disposition== | ==Disposition== | ||
*No evidence/threat of tissue loss: | |||
**Outpatient vascular f/u | |||
*Evidence/threat of tissue loss: | |||
**Vascular consult | |||
==See Also== | ==See Also== | ||
Revisión del 16:05 6 feb 2017
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
Disposition
- No evidence/threat of tissue loss:
- Outpatient vascular f/u
- Evidence/threat of tissue loss:
- Vascular consult