Diagnosis: Thromboangiitis obliterans
Thromboangiitis obliterans (TAO), or Buerger’s disease, is a rare nonatherosclerotic disease that affects the medium and small arteries. The disease has a male predominance, primarily occurs in those younger than 45 years of age, and is most common in people from the Middle and Far East.1 Its distinctive features include ulcerations of the distal extremities and symptoms of claudication and pain at rest. More than 40% of affected patients develop Raynaud’s phenomenon.1 Superficial thrombophlebitis in the form of painful nodules has also been described.2
The etiology of TAO is likely due to disordered inflammation of endothelial cells, which has a strong association with smoking.3 The exact pathogenesis is unknown, but genetics and autoimmunity are suspected contributing factors.
The diagnosis is based on exclusion of other causes
The differential diagnosis includes diabetic angiopathy, embolic disease, atherosclerosis, hypercoagulability/thrombophilia, vasculitis or connective tissue diseases, and drug-associated (eg, cocaine) vasculitis.4
The diagnosis of TAO is based on the exclusion of other causes, although several diagnostic criteria have been proposed, including:
- age <45 years
- current or recent history of tobacco use
- distal extremity involvement (ulcers, claudication, or pain at rest)
- exclusion of diabetes, peripheral artery disease, thrombophilia, or embolic disease
- typical arteriographic findings on imaging, including distal small to medium vessel involvement, segmental occlusions, and “corkscrew-shaped” collaterals.1,2,5,6
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