Recent Updates and Advances in Winiwarter-Buerger Disease (Thromboangiitis Obliterans): Biomolecular Mechanisms, Diagnostics and Clinical Consequences.

Bahare Fazeli,Hiva Sharebiani,Shayan Keramat,Ferdinando Mannello,Rosanna Maniscalco,Daniela Ligi

doi:10.3390/diagnostics11101736

Bahare Fazeli, Hiva Sharebiani + Show 4 more

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https://doi.org/10.3390/diagnostics11101736

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Abstract

Thromboangiitis obliterans (TAO) or Buerger’s disease is a segmental inflammatory, thrombotic occlusive peripheral vascular disease with unknown aetiology that usually involves the medium and small-sized vessels of young male smokers. Due to its unknown aetiology and similarities with atherosclerosis and vasculitis, TAO diagnosis is still challenging. We aimed to review the status of biomolecular and laboratory para-clinical markers in TAO compared to atherosclerosis and vasculitis. We reported that, although some biomarkers might be common in TAO, atherosclerosis, and vasculitis, each disease occurs through a different pathway and, to our knowledge, there is no specific and definitive marker for differentiating TAO from atherosclerosis or vasculitis. Our review highlighted that pro-inflammatory and cell-mediated immunity cytokines, IL-33, HMGB1, neopterin, MMPs, ICAM1, complement components, fibrinogen, oxidative stress, NO levels, eNOS polymorphism, adrenalin and noradrenalin, lead, cadmium, and homocysteine are common markers. Nitric oxide, MPV, TLRs, MDA, ox-LDL, sST2, antioxidant system, autoantibodies, and type of infection are differential markers, whereas platelet and leukocyte count, haemoglobin, lipid profile, CRP, ESR, FBS, creatinine, d-dimer, hypercoagulation activity, as well as protein C and S are controversial markers. Finally, our study proposed diagnostic panels for laboratory differential diagnosis to be considered at first and in more advanced stages.

Highlights

Thromboangiitis obliterans (TAO) or Buerger’s disease is a segmental inflammatory, thrombotic occlusive peripheral vascular disease with unknown aetiology that usually involves the medium and small-sized vessels of young male smokers [1]
During the 1960s, after reporting TAO cases with visceral involvement as well as evidence of atherosclerotic lesions in visceral vessels from the autopsy of some TAO cases, TAO was considered as a type of atherosclerosis obliterans (ASO) with slow collateralization of the lesions and the retrograde extension of the lesions from distal to proximal in comparison with usual cases of ASO
Maybe, when we consider a young smoker with thrombophlebitis migrans and vascular involvement of infrapopliteal arteries and upper limbs, with normal blood sugar, normal lipid profile, and normal blood pressure, with typical skip lesions and corkscrew collaterals in angiography, the TAO diagnosis seems to be easy

Summary

Introduction

Thromboangiitis obliterans (TAO) or Buerger’s disease is a segmental inflammatory, thrombotic occlusive peripheral vascular disease with unknown aetiology that usually involves the medium and small-sized vessels of young male smokers [1]. TAO has geographical distribution, and it is more common in the Middle East, Far East, South-East Asia, Eastern Europe, and South America [2]. There is still no explanation for the geographic distribution of TAO. Due to the unknown aetiology of TAO, its diagnosis is still challenging. Pathology of the acute lesions is pathognomonic for TAO diagnosis [3]. The pathology study is possible on amputees. Even biopsies of superficial thrombophlebitis are not recommended in TAO patients due to the poor circulation of the limb and the risk of developing chronic ulcers at the site of biopsy

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