Etiopathogenesis, clinical diagnosis and treatment of thromboangiitis obliterans – current practices (original) (raw)
Related papers
Thrombo-angitis obliterans: a clinico-pathological study
International Surgery Journal, 2016
Thrombo-angitis obliterans (Buerger's disease) is a clinical syndrome characterized by the presence of segmental thrombosis and occlusions of small and medium sized arteries in the lower and frequently the upper limbs, associated with prominent arterial wall inflammatory cell infiltration. In 1847, Von Winiwater first described thrombo-angitis obliterans (TAO). However, Leo Buerger studied this disease extensively and in 1924 published a book and hence it is also called Winiwater-Buerger's disease. 1,2 Even though TAO is seen worldwide, there is higher prevalence in India, Southeast Asia and eastern European countries than the West. 3-6 It is predominantly seen in young adult male smokers. 4-8 The pathogenesis is poorly understood and most hypotheses are controversial. Smoking is the major aetiological agent in the pathogenesis of this disease. 3-6 However it is unwise to consider this disease to be caused by single aetiological agent i.e. smoking. A lot of questions have to be answered-why is it common in the East where the smoking is universal? Why all heavy smokers do not end up with the disease? Why is it common among the poor ABSTRACT Background: Thrombo-angitis obliterans (TAO) is a disease of young and middle aged individuals who are addicted to smoking from early teens. Greater awareness should be created among the general population regarding smoking, as it is the major cause of TAO. Early diagnosis and management is essential as it is a self limiting disease with complete cessation of smoking. Methods: 50 patients of TAO were selected based on inclusion and exclusion criteria. Data was collected by history, clinical examination and radiological investigation. Patients were treated with conservative management, lumbar sympathectomy, cervical sympathectomy, disarticulation and amputation. Results: Majority of the patients were in the age group of 30-40 years. All the patients were males belonging to low socioeconomic status and chronic smokers. Most of them had right lower limb involvement and presented with rest pain with intermittent claudication. Majority of them were manual workers. 80% of the patients had low temperature in the affected limb. 96% of the patients had dorsalis pedis and posterior tibial arteries involvement. 44 patients underwent lumbar sympathectomy. Ischaemic ulcer healed in 56% of these patients, colour changes improved in 78% and rest pain improved in 42%. Conclusions: TAO was common in males aged 30-40 years belonging to low socioeconomic status. Lower limb was commonly involved. Smoking has a definite role in the development of TAO. Pain was the predominant complaint. Manual labourers were commonly affected. Medium to small calibre vessels were involved. Majority of the patients were treated by lumbar sympathectomy.
Thromboangiitis Obliterans (Buerger's Disease) in a Cigarette Factory Worker: A Case Report
Vascular and Endovascular Surgery, 1992
Thromboangiitis obliterans (TAO) is a nonatherosclerotic, segmental inflammatory disease that most commonly affects the small and medium-sized arteries and veins in the upper and lower extremities. Cigarette smoking has been implicated as the main etiology of the disease. In eastern parts of the world TAO forms 40-60% of peripheral vascular diseases. Clinical features and angiographic finding are the basis of early diagnosis of TAO. Abstinence from smoking is the only definitive treatment to prevent disease progression. Medical management in form of aspirin, pentoxyfylline, cilostazol, and verapamil increase pain-free walking distance in intermittent claudication, but long term usage fails to prevent disease progression in patients who continue to smoke. Surgical treatment in form of revascularization, lumbar sympathectomy, omentopexy, and Ilizarov techniques help reduce pain and promote healing of trophic changes. Newer treatment modalities like spinal cord stimulation, prostacyclin, bosentan, VEGF, and stem cell therapy have shown promising results. Latest treatment options include peripheral mononuclear stem cell, and adipose tissue derived mononuclear stem cells have been shown to be effective in preventing disease progression, decrease major amputation rates, and improving quality of life.
Unexpected Inflammation in the Sympathetic Ganglia in Thromboangiitis Obliterans
International Journal of Angiology, 2017
Thromboangiitis obliterans (TAO) is a segmental thrombotic occlusive peripheral vascular disease with unknown etiology, which usually occurs in young male smokers from low socioeconomic classes and leads to multiple amputations and disability. 1 The progress and prognosis of TAO has a very close relationship with smoking, and approximately half of the patients will undergo amputations (e.g., toe, finger, or limbs) in the absence of smoking cessation. 1,2 Allodynia, circadian rhythmic burning pain which interrupts sleeping, and severe pain during rest, are common manifestations of TAO. 1,3 Prostaglandin I2 or prostaglandin E1 analogs have been the usual treatments for pain management and reducing the risk of major amputation. 4 In addition, sympathectomy has been an option for pain management of TAO patients in recent decades. 4
The American Journal of the Medical Sciences, 2004
The authors report the case of a 42-year-old female mild smoker admitted to the Hospital of Ferrara for the onset of asymptomatic necrotic ulcerations localized to the second, third, and fourth toes of left foot. Physical examination showed asphygmia of inferior limb distal peripheral pulses, with localized extremity marbleized and cyanotic skin at the level of the left foot, where necrotic ulcers were present at the second, third, and fourth toes. Doppler ultrasonography and angiography revealed a severe obliterating arteriopathy of bilateral distal arterial circulation. Both blood chemistry panel (including
Buerger’s disease or thromboangiitis obliterans: description of two cases
Beyond Rheumatology, 2019
Buerger's disease, or thromboangiitis obliterans (TAO), is a segmental non-atherosclerotic occlusive inflammatory condition of small arteries and veins of the upper and lower extremities, characterized by thrombosis and recanalization of the affected vessels. It is triggered by substantial exposure to tobacco, especially in males aged from 20 to 50. Currently, the most effective treatment, together with the suspension of the smoking habit, is represented by prostacyclin infusion (Iloprost). We described two cases of Buerger's disease recently presented to our observation, with some different clinical features and therapeutic pathways.
Thromboangiitis obliterans and endothelial function
European Journal of Clinical Investigation, 2010
Background Endothelial dysfunction may be involved in the pathophysiology of thromboangiitis obliterans (TAO). This study compares endothelial function and large artery stiffness between 10 TAO patients assessed during an exacerbation phase and 10 age-and sex-matched control subjects.
Journal of clinical and diagnostic research : JCDR, 2017
Thromboangitis Obliterans (TAO) or Buerger's disease is a non-atherosclerotic, occlusive, progressive and highly inflammatory disorder of distal arteries seen predominantly affecting the lower limb in smokers. TAO presenting itself in upper limb or bilaterally involving the upper limb is a very rare entity. We report on a rare case of TAO in a 46-year-old gentleman who presented with bilateral upper extremity digital gangrene with 18 pack-years of smoking. Brachial and radial pulses were palpable bilaterally and were of good volume but right ulnar pulse was faintly felt, while on the left side it was not appreciated due to malunion. Further Computed Tomography (CT)- angiography showed occlusion of distal right ulnar artery, stenosis of distal left ulnar artery with bilateral poor opacification of palmar and digital arteries. This case reports on the unusual and rare presentation of TAO in upper extremity involving both limbs. The case is reported for the first time from Malaysia.
Diagnostics
Thromboangiitis obliterans (TAO) or Buerger’s disease is a segmental inflammatory, thrombotic occlusive peripheral vascular disease with unknown aetiology that usually involves the medium and small-sized vessels of young male smokers. Due to its unknown aetiology and similarities with atherosclerosis and vasculitis, TAO diagnosis is still challenging. We aimed to review the status of biomolecular and laboratory para-clinical markers in TAO compared to atherosclerosis and vasculitis. We reported that, although some biomarkers might be common in TAO, atherosclerosis, and vasculitis, each disease occurs through a different pathway and, to our knowledge, there is no specific and definitive marker for differentiating TAO from atherosclerosis or vasculitis. Our review highlighted that pro-inflammatory and cell-mediated immunity cytokines, IL-33, HMGB1, neopterin, MMPs, ICAM1, complement components, fibrinogen, oxidative stress, NO levels, eNOS polymorphism, adrenalin and noradrenalin, lea...