Materiały źródłowe

• #1 Buerger disease – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1148?locale=fr

  Buerger disease is a nonatherosclerotic vasculitis resulting in segmental occlusions of small and medium-sized arteries. […] Laboratory investigations exclude other vascular disease. Appropriate imaging shows medium and small vessel occlusion. Histologic analysis of arterial specimens shows preservation of the internal elastic lamina. […] Diagnostic tests include blood glucose, BUN, serum creatinine, complete blood count (CBC) with differential, coagulation screen, thrombophilia screen, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and arterial Doppler. […] Tests to consider include antinuclear antibody, rheumatoid factor, antineutrophilic cytoplasmic antibody (ANCA), complement levels, anticentromere antibody, topoisomerase I antibodies (Scl-70), echocardiogram, arterial duplex, digital subtraction angiography, and anticardiolipin antibodies. […] Emerging tests include CT angiography, magnetic resonance angiography, tissue biopsy, and genetic testing.

• #1 Diagnostic Criteria for Thromboangiitis Obliterans (Buerger’s Disease) – MedicalCRITERIA.com

  https://medicalcriteria.com/web/reubuerger/

  Since specificity of Buergers disease is characterized by peripheral ischemia of an inflammatory nature and with a self-limiting course, diagnostic criteria should be discussed from clinical of view. […] Several different criteria have been proposed for the diagnosis of thromboangiitis obliterans: […] Diagnostic Criteria of Shionoya: Smoking history; Onset before the age of 50 years; Infrapopliteal arterial occlusions; Either arm involvement or phlebitis migrans; Absence of atherosclerotic risk factors other than smoking. […] Diagnostic Criteria of Olin: Age younger than 45 years; Current or recent history of tobacco use; Presence of distal extremity ischemia indicated by claudication, pain at rest, ischemic ulcers or gangrenes, and documented by non-invasive vascular testing; Exclusion of autoimmune diseases, hypercoagulable states and diabetes mellitus; Exclusion of a proximal source of embolization by echocardiography and arteriography; Consistent arteriographic findings in the clinically involved and noninvolved limbs.

• #1 Buerger’s Disease: Symptoms and Treatment | Doctor

  https://patient.info/doctor/buergers-disease-pro

  Diagnosis based on a list of criteria has been suggested, such as those of Shionoya:8 […] There must also be consistent arteriographic findings in the clinically involved and non-involved limbs. Confident clinical diagnosis of Buerger’s disease requires all five features. Strict clinical diagnostic criteria are essential for any study of a disease to ensure the homogeneity of the selected patient population for valid comparisons. […] There is no specific diagnostic test.11 […] Recommended tests to rule out other causes of vasculitis include FBC, LFTs, renal function tests, fasting glucose, ESR, CRP, autoantibodies and screening for hypercoagulability.12 […] Certain angiographic features are typical (but not pathognomonic) of Buerger’s disease.13 These include a 'corkscrew’ appearance of arteries that results from vascular damage, particularly the arteries in the region of the wrists and ankles. Angiograms may also show occlusions or stenoses in multiple areas of the arms and legs. […] This may be required to exclude a source of recurrent emboli.

• #1 Thromboangiitis obliterans (Buerger’s disease) | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/1750-1172-1-14

  Thromboangiitis obliterans or Buerger’s disease is a segmental occlusive inflammatory condition of arteries and veins, characterized by thrombosis and recanalization of the affected vessels. The clinical criteria include: age under 45 years; current or recent history of tobacco use; presence of distal-extremity ischemia indicated by claudication, pain at rest, ischemic ulcers or gangrenes and documented by non-invasive vascular testing; exclusion of autoimmune diseases, hypercoagulable states and diabetes mellitus; exclusion of a proximal source of emboli by echocardiography or arteriography; consistent arteriographic findings in the clinically involved and non-involved limbs. […] Several different criteria have been proposed for the diagnosis of thromboangiitis obliterans. […] Diagnostic criteria of Olin (2000) include: age under 45 years; current or recent history of tobacco use; the presence of distal-extremity ischemia indicated by claudication, pain at rest, ischemic ulcers or gangrenes and documented by non-invasive vascular testing; exclusion of autoimmune diseases, hypercoagulable states and diabetes mellitus; exclusion of a proximal source of emboli by echocardiography or arteriography; consistent arteriographic findings in the clinically involved and non-involved limbs.

• #1 Thromboangiitis Obliterans (Buerger Disease) Clinical Presentation: History, Physical Examination, Complications

  https://emedicine.medscape.com/article/460027-clinical

  Because a firm diagnosis of thromboangiitis obliterans (TAO; also referred to as Buerger disease), is difficult to establish, a number of different diagnostic criteria have been proposed. In 1990, Olin et al asserted that the following criteria must be met for the diagnosis to be made with reasonable certainty: […] In 1996, Papa et al proposed a point-scoring system to support or contest the diagnosis of TAO on the basis of the following criteria: […] The scoring system is applied as indicated in Table 1 and Table 2 below. […] Table 1. Scoring System for Diagnosis of Thromboangiitis Obliterans […] Table 2. Numerical Scores Defining Probability of Diagnosis of Thromboangiitis Obliterans.

• #1 Buerger disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/buergers-disease/diagnosis-treatment/drc-20350664

  There’s no test that can diagnose Buerger disease. But tests can be done to check for other common conditions that may cause similar symptoms. […] Blood tests may be done to check for diabetes, blood-clotting disorders, or autoimmune diseases such as scleroderma or lupus. […] Blood pressure cuffs and ultrasound imaging are used to see how blood moves through the hands and feet. This test is often done in a special vascular laboratory. […] These tests show blood flow in the arteries. […] This invasive test helps health care providers see blockages in the very small blood vessels of the hands and feet.

• #1 Buerger’s Disease (Thromboangiitis Obliterans): Symptoms, Causes, Tests, Treatment, and More

  https://www.webmd.com/a-to-z-guides/what-is-buergers-disease

  No single test can check for Buergers disease. Your doctor will start by asking about your tobacco use and your symptoms. […] They may do tests to check your blood flow and rule out other diseases that cause similar symptoms. For example, peripheral artery disease also causes pain in your legs, but its caused by plaque building up in your arteries, not inflammation. […] You may also have: […] The Allen test. This is a basic blood flow test. First, you squeeze your hand into a hard fist, which pushes blood out of your hand. Your doctor then presses on the arteries of your wrist to slow the flow of blood back into your hand. At this point, your hand will lose color. When you open your hand, your doctor releases the pressure over the artery on one side of your wrist and then the other side. If it takes a while for your hand to go back to its usual color, it may be a sign of Buergers disease.

• #1 Thromboangiitis Obliterans (Buerger Disease) Workup: Approach Considerations, Laboratory Studies, Arteriography

  https://emedicine.medscape.com/article/460027-workup

  No specific laboratory tests confirm or exclude the diagnosis of thromboangiitis obliterans (TAO; also known as Buerger disease). […] Arteriographic abnormalities consistent with TAO are sometimes seen in limbs that are not yet clinically involved; therefore, arteriography of all four limbs may be required. […] Echocardiography and computed tomography (CT) angiography (CTA) should always be performed in patients thought to have TAO in order to exclude a proximal source of thromboemboli or atheroemboli as the cause of distal vessel occlusion. […] The primary goal of a laboratory workup in patients thought to have the disease is to exclude other disease processes in the differential diagnosis. […] Tests often used as markers for the diagnosis of systemic vasculitis, such as the acute-phase reactants, yield negative results in patients with TAO.

• #1 Buerger’s disease Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/buergers-disease

  How Do You Diagnose Buergers disease? […] To diagnose Buerger’s disease, your doctor may perform some tests to rule out other health problems. […] Buergers disease diagnostic tests may include: […] Physical exam a complete physical exam that checks your pulse. […] Ultrasound uses sound waves to create pictures of the blood flow through your arms and legs. […] Angiogram uses an x-ray and contrast material to show blockages in your blood vessels. […] Computed tomography angiogram (CTA) uses cross-sectional x-rays and a computer to create detailed 3D images.

• #1 Thromboangiitis obliterans – Wikipedia

  https://en.wikipedia.org/wiki/Thromboangiitis_obliterans

  A concrete diagnosis of thromboangiitis obliterans is often difficult as it relies heavily on exclusion of other conditions. […] The commonly followed diagnostic criteria are outlined below although the criteria tend to differ slightly from author to author. Olin (2000) proposes the following criteria: […] Presence of distal extremity ischemia (indicated by claudication, pain at rest, ischemic ulcers or gangrene) documented by noninvasive vascular testing such as ultrasound. […] Exclusion of other autoimmune diseases, hypercoagulable states, and diabetes mellitus by laboratory tests. […] Exclusion of a proximal source of emboli by echocardiography and arteriography. […] Consistent arteriographic findings in the clinically involved and noninvolved limbs. […] Angiograms of the upper and lower extremities can be helpful in making the diagnosis of Buerger’s disease.

• #1 Thromboangiitis Obliterans (Buerger Disease) Workup: Approach Considerations, Laboratory Studies, Arteriography

  https://emedicine.medscape.com/article/460027-workup

  The hallmark angiographic findings in patients with TAO are nonatherosclerotic, segmental occlusive lesions of the small and medium-sized vessels (eg, digital, palmar, plantar, tibial, peroneal, radial, and ulnar arteries) with formation of distinctive small collateral vessels around areas of occlusion, known as corkscrew collaterals. […] Such arteriographic findings suggest TAO but are not pathognomonic, because similar lesions can be observed in patients with scleroderma, CREST syndrome, systemic lupus erythematosus, rheumatoid vasculitis, mixed connective-tissue disease, antiphospholipid-antibody syndrome, and even diabetes mellitus. […] In its acute phase, TAO is characterized by highly cellular, segmental, occlusive, inflammatory thrombi, with minimal inflammation in the walls of affected blood vessels. […] In all three stages of the disease, the integrity of the normal structure of the vessel wall, including the internal elastic lamina, is maintained.

• #1 Buergers Disease – Vasculitis UK

  https://www.vasculitis.org.uk/about-vasculitis/buergers-disease

  Angiograms of the limbs can be helpful in making a diagnosis of the disease. […] Biopsies are not usually recommended as a diagnostic tool for Buergers Disease because of the possibility that the biopsy area may not heal well. Typically blood tests are normal and do not show any evidence of inflammation.

• #1 Buerger’s Disease – Vascular Clinic

  https://vasclin.com/what-we-do/vascular-conditions/buergers-disease/

  The symptoms of Buergers disease may overlap with the symptoms of other vascular diseases. […] Obstruction of blood vessels in the hands and feet caused by Buergers disease may be detected by one of the following diagnostic tests: […] Such diagnostic tests can help to rule out the possibility of atherosclerosis, a different vascular disease in which the blood vessels degenerate. […] Skin biopsies are not typically used to diagnose Buergers disease because of concern that a biopsy site near an area with poor blood circulation will not heal.

• #1 Buerger Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18685

  Classic arteriographic findings include nonatherosclerotic segmental occlusions of the small- and medium-sized arteries (e.g., tibioperoneal, radioulnar, palmoplantar, and digital arteries). Arteriography may show the characteristic „pig-tailing” or „corkscrewing” of the arteries representing small collateral arteries around associated occlusions. However, corkscrew arteries are not specific for TAO. Echocardiography should be obtained to exclude a proximal source of emboli. […] Patients with Buerger disease must be advised again and again to quit all exposure to tobacco products and reassured that if they can quit tobacco use, the disease will go into remission and amputation could be avoided.

• #1 Thromboangiitis Obliterans (Buerger’s Disease)

  https://www.acc.org/Latest-in-Cardiology/Articles/2019/10/21/15/05/Thromboangiitis-Obliterans

  Buerger’s disease or Thromboangiitis Obliterans (TAO) is a segmental non-atherosclerotic inflammatory condition that affects the small and medium sized arteries and veins of the extremities. […] The diagnosis of TAO is based on history, physical examination and diagnostic imaging. It is a diagnosis of exclusion and requires the exclusion of a variety of conditions such as peripheral artery disease, hypercoagulable states, cardiac arrhythmia (with resultant emboli to the digits), vasculitis, and repetitive trauma, to name a few. […] A thorough medical history should include any form of tobacco use (i.e. cigarettes, cigars, smokeless tobacco, electronic cigarettes), nicotine replacement therapy, and cannabis use. Exam should include a full and thorough pulse exam, auscultation for bruits, the Allen test, neurologic exam and visual inspection of the affected limbs.

• #1 Diagnostic criteria and treatment of Buerger’s disease: a review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16698911/

  Buerger’s disease is an inflammatory occlusive disorder affecting the small and medium-size arteries and veins of young, predominantly male, smokers. […] The traditional diagnosis of Buerger’s disease is based on 5 criteria (smoking history, onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, and absence of atherosclerotic risk factors other than smoking). […] As there is no specific diagnostic test and an absence of positive serologic markers, confident clinical diagnosis should be made only when all these 5 criteria have been fulfilled although not universally accepted. […] The angiographic findings in Buerger’s disease („corkscrew,” „spider legs,” or „tree roots”) are helpful but not pathognomonic.

• #1 Early Diagnosis and Intervention Are Needed for a Reasonable Prognosis of Thromboangiitis Obliterans

  https://www.jchestsurg.org/journal/view.html?doi=10.5090/jcs.22.148

  Early Diagnosis and Intervention Are Needed for a Reasonable Prognosis of Thromboangiitis Obliterans […] Thromboangiitis obliterans (TAO) poses a higher risk of amputation than atherosclerosis obliterans. It is characterized by onset at a relatively young age. There are currently no clear treatment guidelines for TAO other than smoking cessation. In this study, we aimed to identify factors that could influence a favorable prognosis of TAO. […] From January 2009 to December 2019, 72 patients were treated for TAO at the Pusan National University Hospital. If 4 or more of the Shionoya criteria were satisfied, TAO (Buerger’s disease) was diagnosed: (1) smoking history, (2) onset before the age of 50 years, (3) infrapopliteal arterial occlusions, (4) upper limb involvement or phlebitis migrans, and (5) absence of atherosclerotic risk factors other than smoking.

• #1 Early Diagnosis and Intervention Are Needed for a Reasonable Prognosis of Thromboangiitis Obliterans

  https://www.jchestsurg.org/journal/view.html?doi=10.5090/jcs.22.148

  A higher initial Rutherford classification category at the time of diagnosis was significantly associated with symptoms persisting or worsening despite treatment (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.04-2.42; p=0.03). Additionally, a higher score for the involved below-knee artery at the time of diagnosis was associated with a worsening disease course despite treatment (OR, 2.26; 95% CI, 1.10-4.67; p=0.03). […] In conclusion, patients with TAO with a higher Rutherford category at the time of diagnosis and a higher involved artery score had a worse prognosis. Initial involvement of more vasculature was associated with a higher likelihood of the disease persisting or worsening. Furthermore, the treatment method did not significantly affect the overall course, but it helped control short-term symptoms.

• #1 Buerger’s Disease : Johns Hopkins Vasculitis Center

  https://www.hopkinsvasculitis.org/types-vasculitis/buergers-disease/

  How is Buergers Disease diagnosed? […] Buergers disease can be mimicked by a wide variety of other diseases that cause diminished blood flow to the extremities. […] Angiograms of the upper and lower extremities can be helpful in making the diagnosis of Buergers disease. […] In the proper clinical setting, certain angiographic findings are diagnostic of Buergers. […] In order to rule out other forms of vasculitis (by excluding involvement of vascular regions atypical for Buergers), it is sometimes necessary to perform angiograms of other body regions (e.g., a mesenteric angiogram). […] Skin biopsies of affected extremities are rarely performed because of the frequent concern that a biopsy site near an area poorly perfused with blood will not heal well.

• #1 Buerger’s Disease Doctor Mumbai, Buerger’s Disease Treatment

  https://www.drpankajpatel.com/buergers-disease.html

  Physical examination will reveal diminished or absent pulses in one or more of the pulses in the foot. Color changes can also be detected during certain physical maneuvers. Non-Invasive vascular studies can detect a decrease in blood flow and pressure in the toes, foot, and/or fingers. […] Buerger’s disease can be mimicked by a wide variety of other diseases that cause diminished blood flow to the extremities. These other disorders must be ruled out with aggressive evaluation, because the treatments may differ substantially from that of Buerger’s Disease (for Buerger’s, there is only one treatment known to be effective: complete smoking cessation – see below). […] Angiograms of the upper and lower extremities can be helpful in making the diagnosis of Buerger’s disease. In the proper clinical setting, certain angiographic findings are diagnostic of Buerger’s. These findings include a „corkscrew” appearance of arteries that result from vascular damage, particularly the arteries in the region of the wrists and ankles. Angiograms may also show occlusions (blockages) or stenosis (narrowing) in multiple areas of both the arms and legs.

• #1

  https://asean-endocrinejournal.org/index.php/JAFES/article/view/3427

  Thromboangiitis obliterans or Buerger’s disease is a non-atherosclerotic segmental inflammatory disease that affects small- and medium-sized arteries and veins. […] There is no consensus or specific markers that can be used in the diagnosis of this disease. The diagnosis is generally made based on clinical criteria and by exclusion of other causes of vascular occlusion. […] Effective treatment modalities for Buerger’s disease are still limited.

• #1 Buerger’s Disease: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21680-buergers-disease

  Your healthcare provider will consider results from: […] Vascular (blood vessel) tests. […] Your provider can look at your blood vessels with these tests: […] Ultrasound. […] Ankle-brachial index (ABI). […] Computed tomography (CT). […] Angiogram. […] Magnetic resonance angiogram (MRA). […] Theres no cure for Buergers disease, but stopping all tobacco, marijuana and nicotine use is the best way to keep Buergers disease from getting worse. […] When people with Buergers disease stop smoking, their symptoms usually get better. […] Specific medicines can help with your Buergers disease symptoms. […] Some medications are helpful in Buergers disease treatment, including: […] Anticoagulants to prevent blood clots. […] You may get relief from Buergers disease symptoms with: […] Surgery for pain or better blood flow. […] Quitting smoking has no side effects. […] If you keep using tobacco products, youll need medicines and possibly surgeries to help you with your symptoms. […] If you have Buergers disease, you should have regular check-ups with your provider.

• #2 Diagnostic criteria and treatment of Buerger’s disease: a review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16698911/

  Buerger’s disease is an inflammatory occlusive disorder affecting the small and medium-size arteries and veins of young, predominantly male, smokers. […] The traditional diagnosis of Buerger’s disease is based on 5 criteria (smoking history, onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, and absence of atherosclerotic risk factors other than smoking). […] As there is no specific diagnostic test and an absence of positive serologic markers, confident clinical diagnosis should be made only when all these 5 criteria have been fulfilled although not universally accepted. […] The angiographic findings in Buerger’s disease („corkscrew,” „spider legs,” or „tree roots”) are helpful but not pathognomonic.

• #2 Thromboangiitis obliterans (Buerger’s disease) | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/1750-1172-1-14

  Thromboangiitis obliterans or Buerger’s disease is a segmental occlusive inflammatory condition of arteries and veins, characterized by thrombosis and recanalization of the affected vessels. The clinical criteria include: age under 45 years; current or recent history of tobacco use; presence of distal-extremity ischemia indicated by claudication, pain at rest, ischemic ulcers or gangrenes and documented by non-invasive vascular testing; exclusion of autoimmune diseases, hypercoagulable states and diabetes mellitus; exclusion of a proximal source of emboli by echocardiography or arteriography; consistent arteriographic findings in the clinically involved and non-involved limbs. […] Several different criteria have been proposed for the diagnosis of thromboangiitis obliterans. […] Diagnostic criteria of Olin (2000) include: age under 45 years; current or recent history of tobacco use; the presence of distal-extremity ischemia indicated by claudication, pain at rest, ischemic ulcers or gangrenes and documented by non-invasive vascular testing; exclusion of autoimmune diseases, hypercoagulable states and diabetes mellitus; exclusion of a proximal source of emboli by echocardiography or arteriography; consistent arteriographic findings in the clinically involved and non-involved limbs.

• #2 Buerger’s Disease: Clinical Aspects and Evidence-Based Treatments | IntechOpen

  https://www.intechopen.com/chapters/59613

  Buergers disease (BD) has a global distribution, with a prevalence in patients with peripheral arterial disease (PAD) that ranges from 0.5 (in western Europe) to 66% (Asian countries, such as Japan and Korea) [1, 4, 5]. […] Because of the lack of clinical or laboratory indicators of Buergers disease and the frequent difficulty in differentiating thromboangiitis obliterans from other vascular pathologies that might affect the extremities, a number of criteria have been published. The simplest criterion is Shionoya [13], which consists of the presence of five mandatory items: (1) history of smoking, (2) beginning before the age of 50, (3) infrapopliteal occlusive lesions, (4) involvement of upper limbs or migratory phlebitis, and (5) absence of atherosclerotic risk factors, with the exception of smoking.

• #2 Early Diagnosis and Intervention Are Needed for a Reasonable Prognosis of Thromboangiitis Obliterans

  https://www.jchestsurg.org/journal/view.html?doi=10.5090/jcs.22.148

  Early Diagnosis and Intervention Are Needed for a Reasonable Prognosis of Thromboangiitis Obliterans […] Thromboangiitis obliterans (TAO) poses a higher risk of amputation than atherosclerosis obliterans. It is characterized by onset at a relatively young age. There are currently no clear treatment guidelines for TAO other than smoking cessation. In this study, we aimed to identify factors that could influence a favorable prognosis of TAO. […] From January 2009 to December 2019, 72 patients were treated for TAO at the Pusan National University Hospital. If 4 or more of the Shionoya criteria were satisfied, TAO (Buerger’s disease) was diagnosed: (1) smoking history, (2) onset before the age of 50 years, (3) infrapopliteal arterial occlusions, (4) upper limb involvement or phlebitis migrans, and (5) absence of atherosclerotic risk factors other than smoking.

• #2 Thromboangiitis obliterans – Wikipedia

  https://en.wikipedia.org/wiki/Thromboangiitis_obliterans

  A concrete diagnosis of thromboangiitis obliterans is often difficult as it relies heavily on exclusion of other conditions. […] The commonly followed diagnostic criteria are outlined below although the criteria tend to differ slightly from author to author. Olin (2000) proposes the following criteria: […] Presence of distal extremity ischemia (indicated by claudication, pain at rest, ischemic ulcers or gangrene) documented by noninvasive vascular testing such as ultrasound. […] Exclusion of other autoimmune diseases, hypercoagulable states, and diabetes mellitus by laboratory tests. […] Exclusion of a proximal source of emboli by echocardiography and arteriography. […] Consistent arteriographic findings in the clinically involved and noninvolved limbs. […] Angiograms of the upper and lower extremities can be helpful in making the diagnosis of Buerger’s disease.

• #2 Buerger’s disease diagnostic study of choice – wikidoc

  https://www.wikidoc.org/index.php/Buerger%27s_disease_diagnostic_study_of_choice

  The following result of catheter-based arteriogram is confirmatory of Buerger disease: Absence of atherosclerosis, No cause for thromboembolism, Small and medium-sized vessels involved, namely tibial, popliteal, and radial arteries, Segmental affection of vessels between normal appearing segments, Corkscrew collaterals described as collateralization around occlusion area but are not pathognomonic. […] The catheter-based arteriogram should be performed when: The patient presents with symptoms and signs that are consistent with Buerger’s disease but not definite. […] The diagnosis of Buerger’s disease is based on the Shionoya’s criteria, which includes: Less than 45 years old, Past or current history of tobacco intake, Ischemia of the distal extremities, Arteriographic findings suggestive of thromboangiitis obliterans, Exclusion of another organic cause such as a source of embolism, autoimmune disease, thrombophilia, or diabetes mellitus.

• #2 Buerger Disease | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-60327-285-8_20

  Buerger disease (thromboangiitis obliterans or TAO) is a rare non-atherosclerotic vascular disease, characterized by a combination of segmental inflammation and thrombosis of medium and small size arteries and veins both in the arms and the legs. […] Various sets of diagnostic criteria have been suggested over the years and the diagnosis requires the elimination of many other diseases. […] New therapeutic modalities have been recently studied in small series, all requiring further evaluation in randomized controlled trials. […] A point scoring system for the clinical diagnosis of Buerger disease.

• #2 Thromboangiitis Obliterans (Buerger Disease) Workup: Approach Considerations, Laboratory Studies, Arteriography

  https://emedicine.medscape.com/article/460027-workup

  No specific laboratory tests confirm or exclude the diagnosis of thromboangiitis obliterans (TAO; also known as Buerger disease). […] Arteriographic abnormalities consistent with TAO are sometimes seen in limbs that are not yet clinically involved; therefore, arteriography of all four limbs may be required. […] Echocardiography and computed tomography (CT) angiography (CTA) should always be performed in patients thought to have TAO in order to exclude a proximal source of thromboemboli or atheroemboli as the cause of distal vessel occlusion. […] The primary goal of a laboratory workup in patients thought to have the disease is to exclude other disease processes in the differential diagnosis. […] Tests often used as markers for the diagnosis of systemic vasculitis, such as the acute-phase reactants, yield negative results in patients with TAO.

• #2 Buerger’s Disease | Mount Sinai – New York

  https://www.mountsinai.org/care/surgery/services/vascular-surgery/conditions/arterial-conditions/buergers-disease

  Buerger’s disease, also called throboangitis obliterans, happens when your small blood vessels become swollen, especially the vessels in your hands and feet. […] No test can confirm that you have Buerger’s disease. We usually diagnose this condition by ruling out more common conditions, such as lupus. We use these tests to diagnose Buerger’s disease: […] Blood tests rule out conditions such as scleroderma, lupus, blood-clotting disorders, and diabetes. […] The Allen Test checks the blood flow through your arteries to your hands. […] Ankle-brachial index (ABI) assesses the blood flow through arteries to your legs. […] Angiograms, scans using computerized tomography or magnetic resonance imaging, can show us the condition of your arteries. We might also do an angiogram using contract dye for greater visibility. […] Ultrasounds use sound waves that can show us any blockages in your blood vessels.

• #2 Buerger’s Disease: Causes, Symptoms, and Treatments

  https://www.healthline.com/health/thromboangiitis-obliterans

  Buergers disease is a clinical diagnosis. This means no specific test determines if you have the disease. To diagnose you, a doctor typically rules out other conditions that can cause symptoms similar to Buergers disease. […] A doctor may order blood tests to rule out conditions that may include: lupus, diabetes, blood clotting disorders. […] If these are negative, a doctor may order tests. This can include: vascular ultrasound, angiogram, an Allen test, which checks blood flow to your hands. […] A positive test result may help a doctor diagnose Buergers disease but could also indicate several other conditions.

• #2 Buerger’s Disease: Symptoms and Treatment | Doctor

  https://patient.info/doctor/buergers-disease-pro

  Diagnosis based on a list of criteria has been suggested, such as those of Shionoya:8 […] There must also be consistent arteriographic findings in the clinically involved and non-involved limbs. Confident clinical diagnosis of Buerger’s disease requires all five features. Strict clinical diagnostic criteria are essential for any study of a disease to ensure the homogeneity of the selected patient population for valid comparisons. […] There is no specific diagnostic test.11 […] Recommended tests to rule out other causes of vasculitis include FBC, LFTs, renal function tests, fasting glucose, ESR, CRP, autoantibodies and screening for hypercoagulability.12 […] Certain angiographic features are typical (but not pathognomonic) of Buerger’s disease.13 These include a 'corkscrew’ appearance of arteries that results from vascular damage, particularly the arteries in the region of the wrists and ankles. Angiograms may also show occlusions or stenoses in multiple areas of the arms and legs. […] This may be required to exclude a source of recurrent emboli.

• #2 Thromboangiitis Obliterans (Buerger’s Disease)

  https://www.acc.org/Latest-in-Cardiology/Articles/2019/10/21/15/05/Thromboangiitis-Obliterans

  Workup should aim to exclude the above differential diagnosis and include: […] Laboratory testing: Serologies for vasculitis and autoimmune syndromes (e.g. CREST syndrome, scleroderma), hypercoagulable states that may result in arterial clots (hyperhomocysteinemia, antiphospholipid antibodies), toxicology screen screening for nicotine and other vasoactive substances (cocaine, amphetamines), blood viscosity, serum and urine electrophoresis. […] An ankle brachial index (ABI) or wrist brachial index (WBI): While a decreased ABI/WBI is revealing, it may be normal in patients with TAO due to the distal nature of the occlusions. Obtaining digit pressures and calculating the digit-brachial index is useful to identify more distal disease. […] A biopsy is not typically needed. It may, however, offer a definitive diagnosis and should be reserved for atypical presentations, or to rule out TAO.

• #2 Thromboangiitis obliterans – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/thromboangiitis-obliterans/

  TAO is a clinical diagnosis that requires: […] Imaging studies (i.e., angiography and echocardiography) can be obtained to rule out other embolic sources and support the diagnosis. […] A biopsy may be indicated in patients with atypical presentations. […] Suspect TAO in a patient old with signs of distal limb ischemia and a history of tobacco consumption. […] The following studies are normal in patients with TAO and should be obtained in all patients to rule out alternative diagnoses: […] ESR and CRP remain within normal limits, which helps differentiate TAO from vasculitides. […] An angiography is preferred over CTA and MRA because of its higher sensitivity for detecting small vessel disease in the extremities. […] Biopsy may be considered in patients with tender nodules and/or superficial thrombophlebitis, atypical locations (e.g., large vessel involvement), or age of onset 45 years. […] Typically shows acute inflammation of all layers of the vessel wall accompanied by occlusive thrombosis.

• #2 Buerger’s Disease: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21680-buergers-disease

  Your healthcare provider will consider results from: […] Vascular (blood vessel) tests. […] Your provider can look at your blood vessels with these tests: […] Ultrasound. […] Ankle-brachial index (ABI). […] Computed tomography (CT). […] Angiogram. […] Magnetic resonance angiogram (MRA). […] Theres no cure for Buergers disease, but stopping all tobacco, marijuana and nicotine use is the best way to keep Buergers disease from getting worse. […] When people with Buergers disease stop smoking, their symptoms usually get better. […] Specific medicines can help with your Buergers disease symptoms. […] Some medications are helpful in Buergers disease treatment, including: […] Anticoagulants to prevent blood clots. […] You may get relief from Buergers disease symptoms with: […] Surgery for pain or better blood flow. […] Quitting smoking has no side effects. […] If you keep using tobacco products, youll need medicines and possibly surgeries to help you with your symptoms. […] If you have Buergers disease, you should have regular check-ups with your provider.

• #2 Buerger’s Disease | Thoracic Key

  https://thoracickey.com/buergers-disease-2/

  A clinical diagnosis of Buergers disease should be supported by vascular laboratory, radiographic, and at times pathologic findings. […] Cited criteria for clinical diagnosis include current or recent smoking history, symptom onset before age 45 years, infrapopliteal arterial occlusive lesions, upper limb involvement, phlebitis migrans, and absence of usual atherosclerotic risk factors other than smoking. […] It has been suggested that at least four of these five criteria must be met for diagnosis. […] Blood assays in patients with suspected Buergers disease are useful to exclude alternative diagnoses. […] Diagnostic vascular laboratory assessment includes segmental blood pressure measurements of all four limbs. […] Digital blood pressure measurements with plethysmography often demonstrate flattened waveforms. […] Contrast arteriography remains the best diagnostic study, especially when the diagnosis is in doubt or arterial reconstruction is contemplated. […] Therefore, a diagnosis must be founded on clinical history supported by vascular laboratory and arteriographic findings.

• #2 Thromboangiitis obliterans – Wikipedia

  https://en.wikipedia.org/wiki/Thromboangiitis_obliterans

  In the proper clinical setting, certain angiographic findings are diagnostic of Buerger’s. […] These findings include a „corkscrew” appearance of arteries that result from vascular damage, particularly the arteries in the region of the wrists and ankles. […] To rule out other forms of vasculitis (by excluding involvement of vascular regions atypical for Buerger’s), it is sometimes necessary to perform angiograms of other body regions (e.g., a mesenteric angiogram).

• #2 Buerger disease | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/buerger-disease?lang=us

  Patients may initially present with nonspecific symptoms such as hand and foot claudication, which eventually progresses to ischemic ulceration. A biopsy is often necessary to make the diagnosis because the imaging appearance and symptoms overlap with those of atherosclerosis and other connective tissue diseases. […] Corkscrew collateral vessels are not, however, pathognomonic for Buerger disease as they may be seen in patients with connective tissue disease.

• #2 Buerger’s Disease : Johns Hopkins Vasculitis Center

  https://www.hopkinsvasculitis.org/types-vasculitis/buergers-disease/

  How is Buergers Disease diagnosed? […] Buergers disease can be mimicked by a wide variety of other diseases that cause diminished blood flow to the extremities. […] Angiograms of the upper and lower extremities can be helpful in making the diagnosis of Buergers disease. […] In the proper clinical setting, certain angiographic findings are diagnostic of Buergers. […] In order to rule out other forms of vasculitis (by excluding involvement of vascular regions atypical for Buergers), it is sometimes necessary to perform angiograms of other body regions (e.g., a mesenteric angiogram). […] Skin biopsies of affected extremities are rarely performed because of the frequent concern that a biopsy site near an area poorly perfused with blood will not heal well.

• #2 Buerger’s Disease (Thromboangiitis Obliterans) – LA Vascular

  https://lavascular.com/buergers-disease-thromboangiitis-obliterans/

  Diagnosis of Buergers disease is typically made based on a combination of clinical symptoms, imaging tests such as angiography, and blood tests. […] A clinical diagnosis without the need for biopsy can be established with the following commonly used criteria: Age less than 45 years, Current or recent history of tobacco use, Distal extremity ischemia (objectively noted on vascular testing), Typical arteriographic findings of thromboangiitis obliterans, Exclusion of autoimmune disease, thrombophilia, diabetes, and proximal embolic sources. […] Imaging studies are not necessary to establish a clinical diagnosis but may be helpful in patients whose clinical features are not definitive. […] Biopsy of a subcutaneous nodule or vein with superficial thrombophlebitis that shows typical acute phase changes on histology provides a definitive diagnosis, but biopsy is not usually needed.

• #2 Buerger’s Disease | Thoracic Key

  https://thoracickey.com/buergers-disease/

  Buergers disease (thromboangiitis obliterans) is a nonatherosclerotic segmental peripheral arterial disease primarily affecting small- and medium-sized vessels of the arms and legs. […] Diagnosis is by exclusion, as detailed above. Commonly measured markers for inflammatory disease (ESR, CRP) and autoantibodies (antinuclear antibody, rheumatoid factor) are usually normal or negative. […] An excisional biopsy is rarely needed but can be obtained from amputations or acute superficial phlebitis for confirmation of the diagnosis. Histopathologic analysis of an acute phase lesion may demonstrate the classic findings of inflammatory cellular thrombi, with relative sparing of the vessel wall and preservation of the internal elastic lamina. Chronic lesions are characterized by organized thrombus and fibrosis.

• #2 Early Diagnosis and Intervention Are Needed for a Reasonable Prognosis of Thromboangiitis Obliterans

  https://www.jchestsurg.org/journal/view.html?doi=10.5090/jcs.22.148

  The Rutherford classification was used to investigate patients’ initial symptoms and course after treatment at the time of diagnosis and 6 months after treatment. Additionally, the patency of the involved artery was investigated using angiography and computed tomography (CT). […] Comparing the Rutherford categories before and after treatment, among the 45 limbs, 23 (51.1%) showed improvement, 11 (24.4%) were maintained, and 11 (24.4%) worsened. Additionally, 9 limbs (20%) underwent amputation: 3 below-knee amputations (6.7%), 1 metatarsophalangeal joint disarticulation (2.2%), and 5 toe amputations (11.1%). […] The degree of disease progression at the time of diagnosis significantly affected patients’ prognosis. Therefore, early diagnosis and intervention are important to improve the course of TAO.

• #2 Buerger Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18685

  Patients with Buerger disease typically present with ischemic signs and symptoms in the distribution of the distal arteries of the upper or lower extremities. Manifestations may include claudication in the arch of the foot as well as the calf. This is also called the Raynaud phenomenon or livedo reticularis that presents as pain in hands, feet, and digits at rest. TAO commonly begins in the distal extremities, but as the disease progresses, it will affect the proximal vessels. The Allen test is done to test the extent of the initial disease. Superficial thrombophlebitis complicates almost half of all cases of TAO. Due to associated neurologic involvement, paresthesias of the acral portions of the upper and lower extremities are often described. […] No specific laboratory tests are available that confirm the diagnosis of Buerger disease. Comprehensive serology should be completed to rule out other causes for ischemic digits including thrombophilic states, diabetes, and autoimmune diseases. Some studies show that the level of anticardiolipin antibody may be a predictor of the age of onset of disease as well as a risk of amputation.

• #2 Buerger’s Disease | The Foundation to Advance Vascular Cures

  https://www.vascularcures.org/buergers-disease

  A rare disorder characterized by inflammation of the small and medium arteries and veins. It affects about 8-11 persons per 100,000 in North America. […] Buergers Disease, also known as Thromboangiitis obliterans (TAO), is a rare disorder characterized by inflammation of the small and medium arteries and veins. It affects about 8-11 persons per 100,000 in North America. […] There are several key factors physicians use to diagnose: […] Rest pain or ulceration under 50 years of age […] Tobacco use […] Tests indicating the arteries are blocked. Typical tests include artery blood flow measurements (such as the ABI or ultrasound), arteriography (pictures of the affected blood vessel obtained by injecting a dye via catheter), and/or biopsy of the affected artery […] No other explanation for artery blockage or clot development. A physician would want to be sure that a clot did not develop from the heart or a large blood vessel and travel to the arm or leg (an embolus) […] The doctor would also want to be certain there had been no blood vessel injury or trauma, no local lesions such as a blood vessel cyst, no autoimmune diseases such as scleroderma, and no blood clotting diseases.

• #2 Buerger Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18685

  Classic arteriographic findings include nonatherosclerotic segmental occlusions of the small- and medium-sized arteries (e.g., tibioperoneal, radioulnar, palmoplantar, and digital arteries). Arteriography may show the characteristic „pig-tailing” or „corkscrewing” of the arteries representing small collateral arteries around associated occlusions. However, corkscrew arteries are not specific for TAO. Echocardiography should be obtained to exclude a proximal source of emboli. […] Patients with Buerger disease must be advised again and again to quit all exposure to tobacco products and reassured that if they can quit tobacco use, the disease will go into remission and amputation could be avoided.

• #3 Thromboangiitis obliterans (Buerger disease) – UpToDate

  https://www.uptodate.com/contents/thromboangiitis-obliterans-buergers-disease

  Thromboangiitis obliterans (Buerger disease) is a nonatherosclerotic, segmental, inflammatory disease that most commonly affects the small to medium-sized arteries and veins of the extremities (upper and lower). […] The epidemiology, clinical manifestations, diagnosis, and treatment of TAO are reviewed here. […] DIAGNOSIS Clinical criteria […] Biopsy.

• #3 Thromboangiitis Obliterans (Buerger Disease) Clinical Presentation: History, Physical Examination, Complications

  https://emedicine.medscape.com/article/460027-clinical

  Because a firm diagnosis of thromboangiitis obliterans (TAO; also referred to as Buerger disease), is difficult to establish, a number of different diagnostic criteria have been proposed. In 1990, Olin et al asserted that the following criteria must be met for the diagnosis to be made with reasonable certainty: […] In 1996, Papa et al proposed a point-scoring system to support or contest the diagnosis of TAO on the basis of the following criteria: […] The scoring system is applied as indicated in Table 1 and Table 2 below. […] Table 1. Scoring System for Diagnosis of Thromboangiitis Obliterans […] Table 2. Numerical Scores Defining Probability of Diagnosis of Thromboangiitis Obliterans.

• #3 Buerger’s Disease: Causes, Symptoms, and Treatments

  https://www.healthline.com/health/thromboangiitis-obliterans

  Buergers disease is a clinical diagnosis. This means no specific test determines if you have the disease. To diagnose you, a doctor typically rules out other conditions that can cause symptoms similar to Buergers disease. […] A doctor may order blood tests to rule out conditions that may include: lupus, diabetes, blood clotting disorders. […] If these are negative, a doctor may order tests. This can include: vascular ultrasound, angiogram, an Allen test, which checks blood flow to your hands. […] A positive test result may help a doctor diagnose Buergers disease but could also indicate several other conditions.

• #3

  https://asean-endocrinejournal.org/index.php/JAFES/article/view/3427

  Thromboangiitis obliterans or Buerger’s disease is a non-atherosclerotic segmental inflammatory disease that affects small- and medium-sized arteries and veins. […] There is no consensus or specific markers that can be used in the diagnosis of this disease. The diagnosis is generally made based on clinical criteria and by exclusion of other causes of vascular occlusion. […] Effective treatment modalities for Buerger’s disease are still limited.

• #3 Thromboangiitis obliterans (Buerger’s disease) | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/1750-1172-1-14

  No specific laboratory test for diagnosing Buerger’s disease is available. […] Recommended tests to rule out other causes of vasculitis include a complete blood cell count; liver function tests; determination of serum creatinine concentrations, fasting blood sugar levels and sedimentation rate; tests for antinuclear antibody, rheumatoid factor, serologic markers for CREST syndrome and scleroderma, and screening for hypercoagulability. […] If a proximal source of embolization is suspected, transthoracic or transesophageal echocardiography and arteriography should be performed. Angiographic findings include severe distal segmental occlusive lesions. […] An abnormal Allen test in a young smoker presenting with leg ulcerations is highly suggestive of TAO.

• #3 Buerger’s Disease – Causes Symptoms Diagnosis & Treatment

  https://www.medindia.net/health/conditions/buergers-disease.htm

  Absence of atherosclerosis in the affected blood vessels […] Collateral blood circulation develops around the occluded areas of the blood vessels […] Echocardiography, to ensure that the clots do not arise in the heart […] Biopsy of the affected vessel, which can confirm the diagnosis of Buerger’s disease […] Buerger’s disease is differentiated from other similar conditions based on the following: […] Acute-phase reactants such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and immunological markers like circulating immune complexes, and autoantibodies such as antinuclear antibody and rheumatoid factor, and complement levels and normal or absent in the blood […] A biopsy of the affected part of the blood vessel shows excess inflammation in the blood clot but the blood vessel wall is relatively spared, and the internal elastic lamina is preserved. A later stage may show recanalization of the blood vessels.

• #3 Buerger’s Disease | Mount Sinai – New York

  https://www.mountsinai.org/care/surgery/services/vascular-surgery/conditions/arterial-conditions/buergers-disease

  Buerger’s disease, also called throboangitis obliterans, happens when your small blood vessels become swollen, especially the vessels in your hands and feet. […] No test can confirm that you have Buerger’s disease. We usually diagnose this condition by ruling out more common conditions, such as lupus. We use these tests to diagnose Buerger’s disease: […] Blood tests rule out conditions such as scleroderma, lupus, blood-clotting disorders, and diabetes. […] The Allen Test checks the blood flow through your arteries to your hands. […] Ankle-brachial index (ABI) assesses the blood flow through arteries to your legs. […] Angiograms, scans using computerized tomography or magnetic resonance imaging, can show us the condition of your arteries. We might also do an angiogram using contract dye for greater visibility. […] Ultrasounds use sound waves that can show us any blockages in your blood vessels.

• #3 Thromboangiitis Obliterans – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/peripheral-arterial-disease/thromboangiitis-obliterans

  Ultrasonography is often used to detect decreased blood flow in the affected extremity. […] Usually, doctors suspect thromboangiitis obliterans on the basis of symptoms and results of the physical examination. In most people, the pulse is weak or absent in one or more arteries of the feet or wrists. […] Angiography can detect specific patterns of narrowing and thus can help confirm the diagnosis. […] Sometimes a biopsy (removal of a tissue sample for examination under a microscope) of the affected artery or referral to a specialist is needed to confirm the diagnosis of thromboangiitis obliterans.

• #3 Buerger’s Disease (Thromboangiitis Obliterans): Symptoms, Causes, Tests, Treatment, and More

  https://www.webmd.com/a-to-z-guides/what-is-buergers-disease

  Angiogram. This is a type of X-ray that checks for blocked blood vessels in your arms and legs. Your doctor places a thin tube, called a catheter, into your artery. They pump dye into the artery and quickly take X-rays to get a look at your blood vessels. A CT or MRI scan can make similar pictures. […] Blood tests. These help your doctor rule out other diseases. They may want to check for conditions like diabetes, lupus, and those that cause blood clots.

• #3 Buerger Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18685

  Classic arteriographic findings include nonatherosclerotic segmental occlusions of the small- and medium-sized arteries (e.g., tibioperoneal, radioulnar, palmoplantar, and digital arteries). Arteriography may show the characteristic „pig-tailing” or „corkscrewing” of the arteries representing small collateral arteries around associated occlusions. However, corkscrew arteries are not specific for TAO. Echocardiography should be obtained to exclude a proximal source of emboli. […] Patients with Buerger disease must be advised again and again to quit all exposure to tobacco products and reassured that if they can quit tobacco use, the disease will go into remission and amputation could be avoided.

• #4 Buerger’s disease diagnostic study of choice – wikidoc

  https://www.wikidoc.org/index.php/Buerger%27s_disease_diagnostic_study_of_choice

  Although clinical examination is sufficient for diagnosis, in cases where diagnosis is not definitive, a catheter-based arteriogram is the gold standard test for the diagnosis of Buerger disease. The following result of catheter-based arteriogram is confirmatory of Buerger disease and includes, absence of atherosclerosis, no cause for thromboembolism, small and medium-sized vessels involved, namely tibial, popliteal, and radial arteries, segmental affection of vessels between normal appearing segments and corkscrew collaterals described as collateralizations around an occlusion area but are not pathognomonic. […] Although clinical examination is sufficient for diagnosis, in cases where diagnosis is not definitive, a catheter-based arteriogram is the gold standard test for the diagnosis of Buerger disease.

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