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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
