Thromboangiitis obliterans

Differential Diagnosis

• Peripheral artery disease
• Thromboembolism
• Vasculitis
• Trauma
• Medication effects, including amphetamines and cocaine

Diagnosis

Clinical Criteria

• Criteria are not universally accepted but include
  • Age less than 50 years (or 45 years)
  • Current or recent tobacco use
  • Ischemia of the distal extremities, documented by vascular testing
  • Typical arteriographic findings, including corkscrew appearance, spider legs, or tree roots
  • Exclusion of other causes, including autoimmune diseases, thrombophilia, diabetes mellitus, and thromboembolism

Investigations

• CBC, liver panel, electrolytes, cretinine, HbA1c, lipid panel, urinalysis
• ESR/CRP
• ANA, RF, cryoglobulins, complements, anti-centromere (for CREST), anti-Scl-70 (for scleroderma), antiphospholipid antibodies
• Protein C & S, antithrombin III, Factor V Leiden, prothrombin, homocysteinemia
• Toxicology for cocaine and amphetamines
• Ultrasound with segmental arterial Dopplers
• Echocardiography (for embolic source)
• +/- CT (for embolic source)
• Biopsy, maybe