Diferencia entre revisiones de «Thromboangiitis obliterans»
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Chronic peripheral artery disease | *Chronic [[peripheral artery disease]] | ||
**Atherosclerosis Obliterans | **Atherosclerosis Obliterans | ||
*Acute PAD | *Acute PAD | ||
| Línea 21: | Línea 21: | ||
**Arterial thrombosis | **Arterial thrombosis | ||
*Vasospastic Disorders | *Vasospastic Disorders | ||
**Raynaud’s | **Raynaud’s disease | ||
**Primary Erythromelalgia | **Primary Erythromelalgia | ||
*Autoimmune | *Autoimmune | ||
**Scleroderma | **[[Scleroderma]] | ||
**SLE | **[[SLE]] | ||
==Evaluation== | ==Evaluation== | ||
Revisión del 13:25 14 feb 2017
Background
- Also known as Thromboangiitis Obliterans
- Idiopathic inflammatory occlusive disease of the hands and feet (exact pathogenesis unknown)
- Risk factors: Male, tobacco users, Middle Eastern
- Virtually all affected patients are smokers
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
Differential Diagnosis
- Chronic peripheral artery disease
- Atherosclerosis Obliterans
- Acute PAD
- Atheroembolism (AKA Blue Toe Syndrome)
- Arterial embolism
- Arterial thrombosis
- Vasospastic Disorders
- Raynaud’s disease
- Primary Erythromelalgia
- Autoimmune
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
- Discharge with vascular follow-up if no evidence/threat of tissue loss
- Otherwise admit