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Thromboangiitis obliterans

Last updated: October 14, 2020

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Thromboangiitis obliterans (TAO, Buerger disease) is an inflammatory, non-atherosclerotic, vaso-occlusive disease of both small and medium-sized arteries as well as veins in the upper and lower limbs. TAO most commonly affects adult males with a significant history of cigarette smoking. In susceptible individuals, smoking causes inflammation of the tunica intima of small vessels by an unknown mechanism, which results in thrombotic occlusion of the vessel. Patients initially present with a classic triad of intermittent claudication, Raynaud phenomenon, and migratory thrombophlebitis. Eventually, critical limb ischemia develops and the patient presents with rest pain, absent pulse in the extremities, and/or digital gangrene. Ultrasonography and arteriography are used to localize the site of occlusion and differentiate TAO from other causes of peripheral artery disease. The most important therapeutic measure is the complete cessation of smoking. Additionally, prostaglandin analogs (e.g., iloprost) may be used to improve blood flow and decrease rest pain. Patients with TAO who develop digital gangrene require amputation.

  • Prevalence: up to 20 cases per 100,000 individuals [1]
  • Sex: > (3:1)
  • Age of onset: before the age of 45 years [2]

Epidemiological data refers to the US, unless otherwise specified.

Patients may present with acute limb ischemia and/or symptoms of chronic peripheral artery disease (see “Clinical features” in “Peripheral artery disease”).

ESR and CRP remain within normal limits.

See “Differential diagnoses” in “Peripheral artery disease.”

The differential diagnoses listed here are not exhaustive.

  1. Olin JW. Thromboangiitis obliterans (Buerger's disease). In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/thromboangiitis-obliterans-buergers-disease.Last updated: October 30, 2015. Accessed: February 13, 2017.
  2. Kumar V, Abbas AK, Aster JC. Robbins & Cotran Pathologic Basis of Disease. Elsevier Saunders ; 2014
  3. Vanda Cristina Jorge, Ana Carolina Araújo, Manuel Vaz Riscado. Buerger’s disease (Thromboangiitis obliterans): a diagnostic challenge. BMJ Case Reports. 2011 .
  4. Perttu ET Arkkila. Thromboangiitis obliterans (Buerger's disease). Orphanet Journal of Rare Diseases. 2006 .