Thromboangiitis obliterans: Difference between revisions
| Line 37: | Line 37: | ||
==Management== | ==Management== | ||
*Abstinence from tobacco | *Abstinence from tobacco | ||
*Early symptoms | *Early symptoms with out threatened tissue loss: outpatient vascular | ||
*Advanced disease: intra-arterial or intravenous PGE1, ASA, Heparin, arterial reconstruction, sympathectomy | *Advanced disease: intra-arterial or intravenous PGE1, [[ASA]], [[Heparin]], arterial reconstruction, sympathectomy | ||
==Disposition== | ==Disposition== | ||
Revision as of 13:26, 14 February 2017
Background
- Also known as Thromboangiitis Obliterans
- Idiopathic inflammatory occlusive disease of the hands and feet (exact pathogenesis unknown)
- Risk factors: Male, tobacco users, Middle Eastern
- Virtually all affected patients are smokers
Clinical Features
- Red, tender nodules over peripheral arteries
- May have diminished pulses
- In-step claudication
- Hand claudication
- Often bilateral and symmetrical
- May lead to ulceration
Differential Diagnosis
- Chronic peripheral artery disease
- Atherosclerosis Obliterans
- Acute peripheral artery disease
- Atheroembolism (AKA Blue Toe Syndrome)
- Arterial embolism
- Arterial thrombosis
- Vasospastic Disorders
- Raynaud’s disease
- Primary Erythromelalgia
- Autoimmune
Evaluation
- Clinical criteria for Dx (noninvasive testing not necessary)
- History of smoking
- Onset prior to <50 y/o
- 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