Abstract
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.
Highlights
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
TAO can be distinguished from other types of vasculitis based on its tendency to occur in young male subjects, its close association with tobacco consumption, the rarity of systemic signs and symptoms, a highly cellular thrombus with relative sparing of the blood vessel wall, and the absence of elevated acute-phase reactants and of immunological markers
Thromboangiitis obliterans (TAO) was first described in 1879, when Felix von Winiwarter, an Austrian surgeon who was an associate of Theodor Billroth, reported in the German Archives of Clinical Surgery a single case of what he described as presenile spontaneous gangrene [1]
Summary
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. In the characteristic acute-phase lesion, in association with occlusive cellular thrombosis, the acute inflammation involving all layers of the vessel wall led TAO to be classified as a vasculitis. TAO can be distinguished from other types of vasculitis based on its tendency to occur in young male subjects, its close association with tobacco consumption, the rarity of systemic signs and symptoms, a highly cellular thrombus with relative sparing of the blood vessel wall, and the absence of elevated acute-phase reactants and of immunological markers. Buerger related the cellular nature of arterial thrombosis, as had von Winiwarter, and described the absence of large vessel involvement. It was Buerger who named the disorder “thromboangiitis obliterans”, and only briefly mentioned its relationship with smoking. In 1924, Buerger reported that tobacco use was probably a predisposing factor [2]
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