Vasculitis

Question 1

What are the features of thromboangiitis obliterans?

Answer 1

Buerger disease:
Non-atheroscletoric, segmental, inflammatory and occlusive dz affecting small-medium sized arteries/veins
Leaves intima intact
Acute phase leads to occlusive thrombi w neutrophilic infiltrate of neurovascular bundle, with microabscesses around periphery of thrombus
Heavily linked with smoking. Also with MJ and cocaine.
Typically in <50yo.
NO inflammatory markers are positive
No real role for biopsy

Question 2

What’s diagnostic criteria for thromboangiitis obliterans?

Answer 2

Shionoya criteria:
Current/recent tobacco
Onset <50 yo
Intrapop arterial occlusion
Either upper limb involvement or phlebitis migrans
Exclusion of atherosclerotic occlusive dz, autoimmune dz, thrombophilia, DMT2, proximal embolic source

Question 3

What should be ruled out for TAO?

Answer 3

ESR, CRP, ANA, rheumatoid factor, complements, anticentromere ab, Scl-70, hypercoag panel, toxicology