Thromboangiitis obliterans


Thromboangiitis obliterans

Description, Causes and Risk Factors:

Abbreviation: TAO.

Inflammation of the entire wall and connective tissue surrounding medium-sized arteries and veins, especially of the legs of young and middle-aged men; associated with thrombotic occlusion and commonly resulting in gangrene.

Thromboangiitis obliterans was first reported by Felix von Winiwarter in 1879 in Austria. It wasn't until 1908, however, that the disease was given its first accurate pathological description, by Leo Buerger at Mount Sinai Hospital in New York City.

The condition occurs when the arteries and veins in the arms and legs become inflamed blocking or reducing blood flow leading to insufficient supply of oxygen and needed nutrients. The trigger for the inflammation and clots however, is not clear, although cigarette smoking is a primary risk factor. The mechanism may also involve delayed hypersensitivity or toxic angiitis. According to another theory, thromboangiitis obliterans may be an autoimmune disorder caused by cell-mediated sensitivity to types I and III human collagen, which are constituents of blood vessels. It occurs more commonly in people with HLA-A9 and HLA-B5 genotypes.

It affects both male and female. It usually occurs between the ages of 20 and 45 but recently it has been seen more in people over the age of 50. The exact prevalence is unknown. In the past decade, however, a dramatic increase in the incidence of female TAO has been observed.

Prognosis markedly improves if a person quits smoking. Female patients tend to show much higher longevity rates than men. The only way to slow the progression of the disease is to abstain from tobacco products.

Symptoms:

    Hands or feet may be pale, red, or bluish.

  • Hands or feet may feel cold.

  • Pain in the hands and feet may be acute or severe, burning or tingling, often occurs at rest.

  • Pain in the legs, ankles, or feet when walking (intermittent claudication), often located in the arch of the foot.

  • Skin changes or ulcers on hands or feet.

  • Raynaud's phenomenon may present.

Diagnosis:

History and physical examination suggest the diagnosis. It is confirmed when the ankle-brachial index (ABI) i.e., the ankle-brachial index test compares your blood pressure measured at your ankle with your blood pressure measured at your arm indicates distal ischemia, when echocardiography excludes cardiac emboli, when blood tests (e.g., measurement of antinuclear antibody (ANA), complement-fixing hidden rheumatoid factor, anticentromere antibody (ACA), anti-SCL-70 antibody exclude vasculitis, when tests for antiphospholipid antibodies (APLAs) exclude antiphospholipid antibody syndrome.

The following tests may show blockage of blood vessels in the affected hands or feet:

  • Angiography/arteriography of the extremity.

  • Doppler ultrasound of the extremity.

Angiography shows characteristic findings (segmental occlusions of the distal arteries in the hands and feet, tortuous, corkscrew collateral vessels around occlusions, and no atherosclerosis).

Treatment:

    There is no known cure for thromboangiitis obliterans. The goal of treatment is to control symptoms. The patient must stop using tobacco and should avoid cold temperatures and other conditions that reduce circulation to the hands and feet.

  • Applying warmth and exercising gently may help increase circulation.

  • Cutting the nerves to the area (surgical sympathectomy) may help control pain. Aspirin and vasodilators may also be used. It may be necessary to amputate the hand or foot if infection or widespread tissue death occurs.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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