Medicine and Man

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Also known as Buerger’s Disease (not to be confused with Berger’s disease which is IgA nephropathy)

Small – medium sized blood vessels involved

Strongly linked to tobacco use – smoking (both active and passive) and nicotine patches

Unclear etiology

More common in men than women (3:1)

Typical age group 20 – 45 years

Clinical Features

Diagnosis of exclusion

Typically age is < 45 years

Current or history of tobacco use

Presence of distal extremity ischemia (indicated by claudication, pain at rest, ischemic ulcers, or gangrene) documented by noninvasive vascular testing

Consistent arteriographic findings in the clinically involved and noninvolved limbs

Patients may describe a Raynaud type phenomenon in hands or fingers

Superficial migratory thrombophlebitis may occur

Parasthesias of hands & feet with impaired distal pulses (proximal pulses are generally normal)

Allen test may be positive

Workup

Labs are typically geared towards ruling out other causes

Angiography – may be required in all limbs as TAO may be clinically silent

Typical angiography features include:

• Nonatherosclerotic
• Segmental
• Involvement of small- and medium-sized vessels
• Formation of distinctive small-vessel collaterals around areas of occlusion known as “corkscrew collaterals”

Echo should always be performed to rule out embolic source

Treatment

Absolute discontinuation of tobacco use

Symptomatic management

• Protective footwear
• Avoid injuries and cold
• Avoid medications which cause vasoconstriction

Surgical options:

• Due to involvement of small vessels bypass grafting has limited value
• Omental transfer
• Sympathectomy
• Spinal cord stimulator implantation