Thromboangiitis obliterans

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

• Red, tender nodules over peripheral arteries
  • May have diminished pulses
• In-step claudication
• Hand claudication
• Raynaud phenomenon
  • Often bilateral and symmetrical
  • May lead to ulceration

Differential Diagnosis

Blue Digit

• Acute arterial ischemia
  • Atheroembolism (AKA Blue Toe Syndrome)
  • Arterial embolism
  • Arterial thrombosis
• Vasospastic Disorders
  • Raynaud’s disease
  • Primary erythromelalgia
• Autoimmune
  • Scleroderma
  • SLE
• Idiopathic
  • Thromboangiitis obliterans (Buerger's disease)
• Chronic peripheral artery disease
  • Atherosclerosis obliterans

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

• Peripheral artery disease

Video

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