thromboangiitis

Thromboangiitis, most commonly referred to as thromboangiitis obliterans or Buerger’s disease, is a nonatherosclerotic inflammatory disease of small- and medium-sized arteries and veins, primarily in the extremities. It is characterized by segmental thrombosis with inflammatory intraluminal thrombi and a tendency toward collateral vessel formation, while the vessel wall is often relatively spared in early stages.

Epidemiology and risk factors are strongly linked to tobacco use. The condition most frequently affects men under 45, though cases in women and older individuals have been reported. A history of heavy smoking or use of tobacco products is present in the vast majority of patients and cessation of tobacco dramatically alters the disease course.

Clinical presentation includes intermittent claudication of the hands and feet, rest pain, digital ulcers, and gangrene in advanced stages. Neurological symptoms due to involvement of the vasa nervorum, such as paresthesias or neuropathic pain, may occur. Raynaud phenomenon can be an accompanying feature. The disease tends to have a relapsing-remitting course with progression related to ongoing tobacco exposure.

Diagnosis is clinical, supported by imaging and laboratory studies. Angiography often shows occlusive disease of distal arteries with irregular, corkscrew-like collateral vessels. Distal involvement with relative sparing of proximal vessels helps distinguish it from atherosclerosis. Laboratory tests are nonspecific; autoimmune markers are typically negative. Biopsy may show acute and chronic inflammatory intraluminal thrombi with preservation of the vessel architecture, but is not always necessary.

Management centers on complete tobacco abstinence, which is essential to halt progression. Other measures include wound care, infection control, pain management, and rehabilitation. Vasodilator and antiplatelet therapies may be used selectively; revascularization is rarely feasible due to the distal, segmental nature of the disease, and amputation may be required for irreversible tissue loss. Prognosis improves with sustained smoking cessation; continued tobacco use is associated with higher risk of limb loss. The condition is historically linked to Leo Buerger, who first described it in the early 20th century.