TAO Flashcards
what is the other name for thromboangiitis obliterans ?
Buerger’s disease
What is TAO?
inflammatory obliterative disease affecting small and medium sized arteries and veins in the extremities
usually young males (30-40 years old )
seen in UE and LE
pathology of TAO?
inflammatory panarteritis or panphlebitis with thrombosis
no necrosis of vessel wall
Lesions are segmental and not diffuse
Lumen of the vessel is occluded by a thrombus with endothelial cells and fobroblasts
no thinning of muscular layer
no accumulation of lipids or calcium
secondary pathologies
due to ischemia of tissues
muscles are atrophied
fat is reabsorbed
dystrophic nails
Attack of TAO last for
1-4 weeks
Exacerbated by nicotine
What are the clinical appearance of TAO?
pain intermittent claudication rest pain pallor with elevation rubor with dependency cold extremity Reynauds phenomenon ulcerations/gangrene
What is the first symptom in TAO?
intermittent claudication
what is the first symptom in ASO?
intermittent claudication
What are the 3 stages of Raynaud’s phenomenon?
1-Pallor- spasm of digital arteries
2-cyanosis-deoxygenated blood pools
3-Rubor- hyperemia
clinical appearance of TAO
ulcerations/gangrene
Thrombophlebitis
Exams to diagnose TAO
Arteriogram
X-ray
What do you see in arteriogram of a pt w/ TAO
Occluded segments of arteries
Multiple collaterals around lesions (corkscrew collaterals)
No irregularites in lumen size
What do you see in an X-ray of a pt with TAO
No calcinosis as in Monkeberg’s
What is the best criteria for diagnosis of TAO?
Histologic exam
What is the differential diagnosis for TAO
ASO
Atherosclerosis
ASO
calcification of the arteries
Variations of the lumen caliber
Atherosclerosis
lipid plaques
Always seen with ASO
treatment for TAO
blood flow is obstructed permanently stop tobacco use bypass the affected segment Anticoagulant therapy sympathectomy (produce vasodilation) Amputation
What is the prognosis for TAO?
poor for survival of the extremity as compared with ASO
ASO has a good bypass success rate
Disseminated Intravascular Coagulopathy
coagulation disorder
Widespread activation of coagulation system
Clotting is great in the vessels (depletes the platelets and coagulation factors and then bleeding results )
Fibrin is deposited in microvasculature and bleeding necrosis is seen on skin
RBC and schistocytes are seen in blood
PT and PTT are elevated
Etiology of DIC
Infection
Abnormal production of procoagulant tissue factors (in tumors)
Endothelial damage (Burns or Rocky Mountain spotted fever)
Treatment for DIC?
Plasma and platelet transfusion
IV heparin to interrupt coagulation ( difficult to do bc the pt is already bleeding)
Non invasive vascular testing
Palpation of pulses Doppler ultrasound ABI/TBI Segmenta pressure PPG TcPO2
Triphasic form is
- Ventricular Systole (1st upstroke )
- Diastole (deflection)
- Elastic Recoil (dichrotic notch )
accute BP are taken when the fuff’s width is approximately
40% of the limb’s circumference
or
20% greater than the limb’s diameter
Toe brachial index
calculated by dividing toe systolic pressure by brachial systolic pressure
TBI > 30 mmHg may be an indicator of
Healing potential in DFU
Tranascutaneous oxygen pressure (TCPO2) is useful in
advanced stages of arteriopathy for evaluation of cutaneous ischemia
