Thromboangiitis Obliterans

Abstract

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 (Lie et al., Mayo Clin Proc 54:802–807, 1979). In 1908, Leo Buerger, a physician at Mount Sinai Hospital (New York, NY, USA), noticed the same condition in 11 amputated limbs of patients of Jewish descent, describing the absence of large vessel involvement and termed the disease ‘thromboangiitis obliterans’ and in 1924 briefly reported a possible relationship with tobacco (Buerger, The circulatory disturbances of the extremities. Philadelphia, PA: WB Saunders; 1924). In 1922, Allen and Brown reported 200 cases of TAO from 1922 to 1926 and noticed that all were male smokers (Mills et al., Am J Surg 154:123–129, 1987). TAO or Buerger’s disease is a segmental inflammatory arteriopathy affecting mostly medium- and small-sized vessels both arterial and venous in the lower and upper extremity. In some Eastern countries, this vasculitis can represent up to 40–60 % of all peripheral vascular diseases (PVD) (Joviliano et al., Int J Angiol 18:119–125, 2009; Weinberg and Jaff, Circulation 126:213–222, 2012). The disease affects mostly young male smokers and tends to present with rest pain and tissue loss. Tobacco exposure is strongly associated with initiation and progression of the disease even if the real mechanism remains still unclear. Since atherosclerotic risk factors other than smoking are commonly absent, smoking cessation is the only way to stop the disease progression. Clinical features, patient’s history and angiographic findings are the basis of early diagnosis of TAO.