Makindo Medical Notes.com

Thromboangiitis Obliterans is a non-atherosclerotic inflammatory disease of unknown aetiology, which has a strong association with tobacco. This panarteritis affects men ages between 25 and 35 years and can involve arteries, veins and nerves of the arm and legs

About

• Commonest in young male smokers age 20-40
• Seen in those from the Mediterranean region or North Africa.

Aetiology

• An inflammatory disease of the arteries
• Distinct to atherosclerosis
• Often affects males young age 20-30 smokers
• Affects distal vasculature. Different to atherosclerosis
• Affects both veins AND arteries AND Nerves.
• Deep vein thrombosis, Arterial disease, Distal neuropathy

Clinical

• Claudication in the legs and also hands and arms
• May even have rest pain
• Loss of peripheral upper and lower lib pulses radial and dorsalis pedis
• Brachial and popliteal may be preserved

Shionoya clinical criteria.

• 1. Smoking history
• 2. Onset before the age of 50 years
• 3. Infrapopliteal arterial occlusions
• 4. Either upper limb involvement or phlebitis migrans
• 5. Absence of atherosclerotic risk factors other than smoking

Investigations

• ESR and CRP are typically normal unlike other vasculitides
• Angiography shows disease

Management

• Stop smoking. Antiplatelets and other drugs may be tried but are often ineffective.
• Prostacyclin, Calcium channel blockers, sympathectomy may be considered
• Amputation may be required in those who continue to smoke

References

• Buergers disease