Short review of diagnosis and revascularization for thromboangiitis obliterans

Abstract

This short review focuses on recent diagnostic criteria and outcomes after revascularization in thromboangiitis obliterans (TAO, Buerger disease). The incidence and disease have decreased worldwide, including in Eastern Asia, except in regions where inexpensive tobacco products are widely consumed. However, the global epidemiology remains unclear due to the lack of definitive diagnostic biomarkers. Clinical diagnostic criteria are also not standardized but have been updated according to medical advances and current patient characteristics. Notably, neither of the two recently proposed criteria excludes patients with risk factors for atherosclerosis, as these conditions may coexist with TAO and are often seen in young patients. Young age at onset is no longer essential. Objective test findings are required, and typical vascular imaging findings are essential for definitive diagnosis. Suspected diagnosis is allowed for patients who have difficulty undergoing tests. Revascularization for TAO is typically directed at below-the-knee lesions, which are characterized by poor distal runoff, associated inflammation, and prone to spasm. Recently, both bypass surgery (BS) and endovascular treatment (EVT) have shown improved outcomes. Two studies on BS published after 2000 reported primary patency rates exceeding 50% at 3 years. A systematic review and meta-analysis of EVT, which mostly consisted of balloon angioplasty, revealed that multiple reinterventions were often required; however, the secondary patency and limb salvage rates at 3 years were comparable to those of BS. Short-term arterial patency, whether achieved by BS or EVT, can be sufficient for ulcer healing. Given that TAO is a highly thrombogenic condition, the administration of potent antithrombotic therapy during and after revascularization is crucial to maintain arterial patency.