Buerger Disease (Thromboangiitis Obliterans)

Current or recent chronic tobacco/nicotine exposure

Ashkenazi Jewish ethnicity; prevalence much greater in Eastern Europe, Southeast Asia, and India

Age <45, male gender (M:F ratio: 10–100:1)

Incidence in USA: Progressively decreasing in association with decreasing smoking prevalence; <8–10/100,000

Similar to any pt with chronic tobacco exposure

Risks to already compromised perfusion of distal extremities

Coexisting pulm disease in tobacco smokers

Abnormal Allen test result in a young (<45 y) male smoker with leg ulcerations (classic clinical scenario for Buerger)

All extremities because TAO is never confined to a single limb

Inflammatory vasculitis of small and medium arteries and veins in extremities.

Classic distribution is infrapopliteal or distal to the brachial artery.

Results in extremity ischemia leading to claudication of calf, foot, forearm, or hands.

Severe ischemia results in ulcerations and gangrene progressing to necrosis and eventual amputation of ischemic extremity.

Olin (2000) criteria:

• Age <45 y.

• Current or recent history of tobacco use.

• Presence of distal-extremity ischemia indicated by claudication, rest pain, ischemic or gangrenous ulcers, and documentation by noninvasive vascular testing.

• Exclusion of autoimmune diseases (scleroderma, CREST, sclerodactyly, and telangectasia), hypercoagulable states (antiphospholipid syndrome or homocysteinemia), or DM.

• Exclusion of proximal embolic source by ECHO or angiography.

Diagnosis confirmed with biopsy of active lesion showing a highly cellular thrombus formation with neutrophils, giant cells, and microabscesses but intact internal elastic lamina: differentiates from other vasculitis conditions.

Antiendothelial antibody titers may allow tracking of disease progression and severity.

Lesions occasionally occur in coronary, mesenteric, and cerebral vasculature but always present initially in extremities.