Thromboangiitis obliterans
Background
- AKA Thromboangiitis Obliterates
Pathophysiology
- Idiopathic inflammatory occlusive disease of the hands and feet
- Exact pathogenesis unknown
Risk Factors
- Male, tobacco, Middle Eastern
- Virtually all patients are smokers
Clinical Features
- Red, tender nodules over peripheral arteries
- +/- diminished pulses
- In-step claudication
- Hand claudication
- Often bilateral & symmetrical
- May lead to ulceration
Differential Diagnosis
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 w/o threatened tissue loss: outpatient vascular
- Advanced disease: intra-arterial or intravenous PGE1, ASA, Heparin, arterial reconstruction, sympathectomy