Thromboangiitis obliterans: Difference between revisions
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==Background== | ==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 | |||
* Idiopathic inflammatory occlusive disease of the hands and feet | **Virtually all affected patients are smokers | ||
**Virtually all patients are smokers | |||
==Clinical Features== | ==Clinical Features== | ||
*Red, tender nodules over peripheral arteries | *Red, tender nodules over peripheral arteries | ||
** | **May have diminished pulses | ||
*In-step claudication | *In-step claudication | ||
*Hand claudication | *Hand claudication | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Chronic | *Chronic peripheral artery disease | ||
**Atherosclerosis Obliterans | **Atherosclerosis Obliterans | ||
*Acute PAD | *Acute PAD | ||
**Atheroembolism (AKA Blue Toe Syndrome) | **Atheroembolism (AKA Blue Toe Syndrome) | ||
**Arterial embolism | **Arterial embolism | ||
**Arterial thrombosis | **Arterial thrombosis | ||
*Vasospastic Disorders | *Vasospastic Disorders | ||
**Raynaud’s Disease | **Raynaud’s Disease | ||
**Primary Erythromelalgia | **Primary Erythromelalgia | ||
*Autoimmune | *Autoimmune | ||
**Scleroderma | **Scleroderma | ||
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==Disposition== | ==Disposition== | ||
* | *Discharge with vascular follow-up if no evidence/threat of tissue loss | ||
*Otherwise admit | |||
* | |||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Vascular]] | |||
Revision as of 22:30, 6 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 & symmetrical
- May lead to ulceration
Differential Diagnosis
- Chronic peripheral artery disease
- Atherosclerosis Obliterans
- Acute PAD
- Atheroembolism (AKA Blue Toe Syndrome)
- Arterial embolism
- Arterial thrombosis
- Vasospastic Disorders
- Raynaud’s Disease
- Primary Erythromelalgia
- Autoimmune
- Scleroderma
- SLE
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
Disposition
- Discharge with vascular follow-up if no evidence/threat of tissue loss
- Otherwise admit