Thromboangiitis obliterans of coronary and internal thoracic arteries in a young woman

Donatelli, Francesco; Triggiani, Michele; Nascimbene, Simona; Basso, Cristina; Benussi, Stefano; Chierchia, Sergio; Thiene, Gaetano; Grossi, A

doi:10.1016/s0022-5223(97)70243-5

Cited by 35 publications

(9 citation statements)

References 8 publications

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“…Similar pathophysiologic findings have been noted in case reports involving the coronary and internal thoracic arteries [18], mesenteric arteries and veins [19], and the cerebral vessels (also referred to as Spatz-Lindenberg disease) [20]. The diagnostic criteria for these unusual forms of TAO remain unclear, however, given the small number of cases reported.…”

Section: Opinion Statementsupporting

confidence: 62%

Thromboangiitis Obliterans (Buerger’s Disease)

Jaff

2000

Curr Treat Options Cardio Med

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Thromboangiitis obliterans (TAO) is a devastating nonatherosclerotic disease that often leads to digit and limb loss as well as intractable ischemic rest pain. Patients with TAO are uniformly heavy users of tobacco. This disorder is characterized as a miscellaneous form of vasculitis affecting small- and medium-sized arteries and veins. TAO causes painful ischemic ulcers of the digits and unusually painful and inflammatory superficial thrombophlebitis. The key to early diagnosis of TAO is a high clinical index of suspicion in the appropriate patient scenario, exclusion of any other potential cause, abnormal results from an Allen's test, and arteriographic findings of segmental digital arterial occlusions with "corkscrew" collateral vessels. The primary and clearly most effective therapy for TAO is cessation of the use of all tobacco products, with avoidance of any environmental tobacco smoke inhalation. There has been recent enthusiasm for prostaglandin E therapy and the intramuscular injection of angiogenic growth factors. For patients in whom the disease is identified late or for those who are unable to discontinue cigarette smoking, however, a frequent result is multiple limb amputations.

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Section: Opinion Statementsupporting

confidence: 62%

Thromboangiitis Obliterans (Buerger’s Disease)

Jaff

2000

Curr Treat Options Cardio Med

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“…Such involvement had been considered extremely rare until the 1980s, but more than ten cases have been reported during the last decade. 1,[9][10][11][12][13][14] Among these unusual forms of TAO, an intestinal type seems to be most common. Broide and associates reported the case of a young man with the unusual presentation of small bowel ischemia associated with TAO, 2 years before peripheral vascular disease of the extremities was clinically expressed.…”

Section: Discussionmentioning

confidence: 99%

Distribution of arterial involvement in thromboangiitis obliterans (buerger’s disease): Results of a study conducted by the Intractable Vasculitis syndromes research group in Japan

et al. 2000

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The clinical profile of thromboangiitis obliterans (TAO) has been changing. The purpose of this study was to clarify the distribution of arterial involvement in this disease, based on a nationwide survey carried out in 1993. A total of 825 TAO patients with complete records were analyzed. There were 749 men and 76 women, with a mean age of 50.8 +/- 0.4 years. The survey assessed clinical manifestations categorized by Fontaine's classification, distribution of the lesions, associated diseases, responses to treatment, and outcome. This study focused on the distribution of arterial involvement. There were 42 patients (5.1%) with upper-extremity arterial involvement only, 616 (74.7%) with lower-extremity involvement only, and 167 (20.2%) with both. The most frequently affected arteries were the anterior (41.4%) or posterior (40.4%) tibial arteries in the lower extremities, and the ulnar artery (11.5%) in the upper extremities. There were no significant differences in the distribution of arterial involvement between men and women or between the right and left sides. In conclusion, approximately 25% of the patients had upper-extremity involvement. The anterior or posterior tibial arteries were most commonly affected. There was no significant difference in the distribution of arterial involvement between male and female patients.

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“…On the other hand, documentation based on histological findings of atypical TAO, e.g., that affecting women [11,14], visceral or cerebral blood vessels [11,16,37], a diabetic patient [14] and nonsmokers [11,14] has been increasing. Therefore, there is a question of whether there is room for over-or underdiagnosis.…”

Section: Introductionmentioning

confidence: 99%

Thromboangiitis obliterans: classic and new morphological features

et al. 2000

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The clinical and pathological concept of thromboangiitis obliterans (TAO, Buerger's disease) is still controversial. While the clinical criteria of TAO are relatively well defined, the etiology is unknown and its diagnosis based on pathology is confusing, since there is no consensus on the precise pathological criteria for TAO. To investigate the morphological features that differentiate TAO from arteriosclerosis obliterans (ASO) or thromboembolism, and to clarify the morphological independence of TAO, we studied 94 amputated specimens of lower extremities, including 31 specimens from patients with a clinical diagnosis of TAO and 31 autopsy specimens as control cases. It was revealed that most of the classic morphological features described by Buerger and others are not helpful when considered independently in the differential diagnosis, except for intact internal elastic lamina. In addition, findings of intimal inflammation, intact media and absence of medial calcification were demonstrated to be common in both TAO and thromboembolism. Statistical analysis in the present study, the most comprehensive thus far, showed that novel findings of onion-like-shaped recanalizing vessels in the occluded arteries, adventitial fibrosis without medial fibrosis, swelling of the endothelium of the vasa vasorum and edema beneath the external elastic lamina were characteristic of TAO and would be helpful in a differential diagnosis. When a combination of these morphological features is present, diagnosis of a presumed overlap of TAO and ASO in the same site of the vessel concerned is possible. Furthermore, comparison of statistical evaluations based on morphological features performed in various diagnostic groups implies that the clinical diagnosis of TAO is currently underestimated because the results of the analysis of morphological features of specimens in which TAO was suspected or specimens selected on the basis of a broad and nonspecific definition of TAO were surprisingly similar to the results in strictly defined TAO cases. Our findings suggest that injury and regeneration of minute vessels such as recanalizing vessels and vasa vasorum play a part in the pathogenesis of TAO.

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Thromboangiitis obliterans of coronary and internal thoracic arteries in a young woman

Cited by 35 publications

References 8 publications

Thromboangiitis Obliterans (Buerger’s Disease)

Thromboangiitis Obliterans (Buerger’s Disease)

Distribution of arterial involvement in thromboangiitis obliterans (buerger’s disease): Results of a study conducted by the Intractable Vasculitis syndromes research group in Japan

Thromboangiitis obliterans: classic and new morphological features

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