Obliterant tromboangitis is an occlusive vascular disease that comprises middle and small arteries, and distal extremities veins. His prevalence is bigger in Asian population and masculine population with less than 40 years. There is no evidence about the cause but there is an association with cigarettes.
In the lesion place are polymorphic nuclear cells. Later, arrives monocytes, fibroblasts and giant cells. In advance disease is very frequent perivascular fibrosis. There is no intime layer compromise but it can be thrombus formation.
Clinical
The patient with tromboangitis presents a triad: extremity claudication, Reynaud phenomena and migrans thrombo-phlebitis. The patient conserves the humeral and popliteal pulse, but radial, ulnae and pedis pulse are absent. It can present nail atrophy, vessels ulcers and gangrene lesions. Therefore, extremities claudication is localized in calf and feet, and superior extremity claudicate on the hand and forearm.
The first image shows a patient with a hanged-foot and the second after elevation.
Dx
The diagnostic is via excicional biopsy and pathological study. Arteriography is very useful.
Treatment
There is no treatment; the only recommendation is to cease smoking, while this neither warranty nothing cause probably won’t improve. Can proceeds with angioplasty derived from big arteries. Anticoagulation and corticoids doesn’t work.
References: Harrison - Intern Medicine - 16º Edition.
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