Has the clinical definition of thromboangiitis obliterans changed indeed?

Barlas, Semih; Elmaci, Türkan; Dayıoğlu, Enver; Alpagut, Ufuk; Onursal, Ertan; Kargi, Aydın; Barlas, Cemil

doi:10.1007/bf01616231

Cited by 10 publications

(6 citation statements)

References 20 publications

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“…In the series reported by Shionoya and Rutherford [27], two limbs were affected in 16% of patients, three limbs in 41%, and all four limbs in 43% of patients. In a study by Barlas et al [28] patients with TAO (2468 total; 94.5% men and 5.5% women) at the time of admission, 78.2% had rest pain, 58% had intermittent claudication, 17.6% had supericial thrombophlebitis, 10.5% had Raynaud's phenomenon, and 68.9% had ischemic ulcers. A staging system for clinical symptoms was proposed by Rutherford as described in Table 1.…”

Section: Clinical Featuresmentioning

confidence: 99%

Thromboangiitis Obliterans (Buerger’s Disease)—Current Practices

Vijayakumar

Tiwari

Prabhuswamy

2013

International Journal of Inflammation

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Thromboangiitis obliterans (TAO) is a nonatherosclerotic, segmental inflammatory disease that most commonly affects the small and medium-sized arteries and veins in the upper and lower extremities. Cigarette smoking has been implicated as the main etiology of the disease. In eastern parts of the world TAO forms 40–60% of peripheral vascular diseases. Clinical features and angiographic finding are the basis of early diagnosis of TAO. Abstinence from smoking is the only definitive treatment to prevent disease progression. Medical management in form of aspirin, pentoxyfylline, cilostazol, and verapamil increase pain-free walking distance in intermittent claudication, but long term usage fails to prevent disease progression in patients who continue to smoke. Surgical treatment in form of revascularization, lumbar sympathectomy, omentopexy, and Ilizarov techniques help reduce pain and promote healing of trophic changes. Newer treatment modalities like spinal cord stimulation, prostacyclin, bosentan, VEGF, and stem cell therapy have shown promising results. Latest treatment options include peripheral mononuclear stem cell, and adipose tissue derived mononuclear stem cells have been shown to be effective in preventing disease progression, decrease major amputation rates, and improving quality of life.

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Section: Clinical Featuresmentioning

confidence: 99%

Thromboangiitis Obliterans (Buerger’s Disease)—Current Practices

Vijayakumar

Tiwari

Prabhuswamy

2013

International Journal of Inflammation

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“…Complete abstinence is crucial because a reduction in tobacco exposure does not prevent progressive tissue necrosis and limb loss [19]. In a large study of almost 2,500 patients, tobacco absence led to an amputation rate of 5.7 % compared to an amputation rate of 46 % in patients with continuing tobacco consumption [20]. Many diff erent vasodilating agents have been proposed for acute management of patients with TAO, although iloprost is the only one that has been evaluated in randomized trials.…”

Section: Discussionmentioning

confidence: 99%

Conservative treatment of patients with thromboangiitis obliterans or cannabis-associated arteritis presenting with critical lower limb ischaemia

Galyfos

Kerasidis

Kastrisios

et al. 2017

Vasa

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Summary: Background:Proper management of patients with thromboangiitis obliterans (TAO) or cannabis-associated arteritis (CAA), presenting with critical lower limb ischaemia (CLI) remains controversial, and data are limited. Patients and methods: Patients with TAO or CAA presenting with CLI between 2011 and 2016 were retrospectively evaluated. Patients requiring primary intervention were excluded. Conservative treatment included: (a) weight-adjusted bemiparin plus six hours/day intravenous iloprost for 28 days, (b) aspirin (100 mg/day) plus cilostazol (100 mg twice/day) after discharge, and (c) strict recommendations/monitoring for smoking cessation. Main outcomes included symptom recession, ankle-brachial index (ABI) improvement, and healing of lesions at the time of discharge as well as amputation, revascularization, and abstinence rate during follow-up. Results: Overall, 23 patients (TAO: 15; CAA: 8) were included within six years, none of the patients reported any other factor than smoking. All patients presented with rest pain and 12 patients with ulcer or necrotic lesions. Mean ABI measurement at presentation was 0.46 ± 0.2, after 28 days of treatment, all patients showed improvement regarding clinical picture and ABI measurement (0.54 ± 0.1; p < 0.05). During follow-up, only three patients underwent bypass surgery and two patients underwent major amputation, although the smoking abstinence rate was very low (13 %). Conclusions: Intravenous iloprost plus bemiparin for 28 days together with per os aspirin plus cilostazol seem to produce promising results in patients with TAO/CAA, treated for CLI, even with a low smoking abstinence rate. However, larger series are needed to further evaluate inter-group differences and potential prognostic factors.

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“…Angiographic findings are considered relevant in patients older than 40 years of age, and young female or male passive or active smokers. The absence of gangrenous limbs or end-stage ischemic ulcers, and previous sympathectomy (chest, bilateral lumbar, thoracic and lumbar, lumbar and unilateral) may also be important in the clinical diagnosis of TAO (26).…”

Section: Diagnostic Criteriamentioning

confidence: 98%

“…Moreover, Barlas et al (26) described a study in a group of patients with TAO (2468 total; 94.5% men and 5.5% women) who were treated between 1975 and 1992 at the Thoracic and Cardiovascular Surgery Department, Istanbul Medical Faculty, Istanbul University (Istanbul, Turkey). Mean (± SD) age was 43±10 years (range 23 to 80 years) at the time of diagnosis.…”

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confidence: 98%

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Etiopathogenesis, clinical diagnosis and treatment of thromboangiitis obliterans – current practices

Joviliano¹,

Dellalibera-Joviliano²,

Dalio³

et al. 2009

Int J Angiol

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Thromboangiitis obliterans (TAO) is a segmental inflammatory occlusive disorder that affects small- and medium-sized arteries, and arm and leg veins of young smokers. Several different diagnostic criteria have been offered for the diagnosis of TAO. Clinically, it manifests as migratory thrombophlebitis or signs of arterial insufficiency in the extremities. It is characterized by highly cellular and inflammatory occlusive thrombi, primarily of the distal extremities. Thromboses are often occlusive and sometimes display moderate, nonspecific inflammatory infiltrate, consisting mostly of polymorphonuclear leukocytes, mononuclear cells and rare multinuclear giant cells. The immune system appears to play a critical role in the etiology of TAO. However, knowledge about immunological aspects involved in the progression of vascular tissue inflammation, and consequently, the evolution of this disease, is still limited. There are several studies that suggest the involvement of genetic factors and results have shown increasing levels of antiendothelial cell antibodies in patients with active disease. Vasodilation is impaired in patients with TAO. TAO disorder may actually be an autoimmune disorder, probably initiated by an unknown antigen in the vascular endothelium, possibly a component of nicotine. There are various therapies available for treatment of TAO, but the major and indispensable measure is smoking cessation. Except for discontinuation of tobacco use, no forms of therapy are definitive. Sympathectomy, cilostazol and prostaglandin analogues (prostacyclin or prostaglandin E) have been used in specific conditions. Recently, therapeutic angiogenesis with autologous transplantation of bone marrow mononuclear cells has been studied in patients with critical limb ischemia.

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Has the clinical definition of thromboangiitis obliterans changed indeed?

Cited by 10 publications

References 20 publications

Thromboangiitis Obliterans (Buerger’s Disease)—Current Practices

Thromboangiitis Obliterans (Buerger’s Disease)—Current Practices

Conservative treatment of patients with thromboangiitis obliterans or cannabis-associated arteritis presenting with critical lower limb ischaemia

Etiopathogenesis, clinical diagnosis and treatment of thromboangiitis obliterans – current practices

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