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Vasculitic Syndrome: Thromboangiitis Obliterans (aka Buerger’s Disease) Clinical Presentation:
Triad of symptoms/signs:
Distal arterial occlusion
Leads to arm and foot claudication
Ischemia of the digits
Raynaud’s phenomenon (see Diseases Causing Arterial Spasm study guide)
Migrating superficial vein thrombophlebitis (inflammation of a vein caused by a blood clot)
Etiology & some Epidemiology:
Strongly associated with smoking.
Increased incidence of HLA-A9 and HLA-B5 in Thromboangiitis Obliterans patients.
Most common in men < 40 years old.
Only 2% of cases in females.
Thromboangiitis Obliterans is an inflammatory disease of small and medium size arteries, veins, and nerves.
It involves distal vessels of upper and lower extremities.
Histologic examination of affected areas of arteries shows:
Inflammation and thrombosis without necrosis
Preservation of internal elastic lamina
Distal to the involved vessel, get ischemia that damages tissues.
Cannot detect and thus cannot use traditional lab markers for inflammation and autoimmune disease.
Arteriograph: see areas of stenosis interspersed w/ normal appearing vessels; more severe disease distally; collateral vessels with “corkscrew” appearance around stenotic regions; no atherosclerosis in proximal arteries
Tissue Biopsy: diagnosis can be established this way – but rarely need to do this
Biopsy of involved vessel: reveals an occlusive, highly cellular, inflammatory thrombus – limited vessel wall involvement, preservation of the internal elastic lamina
Only treatment is to STOP SMOKING…
Prevents progression of disease and complications