Buerger's Disease (Thromboangiitis Obliterans)

Thromboangiitis obliterans — non-atherosclerotic vasculitis affecting small + medium-sized vessels of distal limbs. Most commonly: men 20–45y, heavy smokers (or smokeless tobacco). Features: • Distal limb ischaemia: cold, pain, ulceration, gangrene of digits / fingers / toes. • Migratory superficial thrombophlebitis. • Raynaud's phenomenon. • Claudication of arch / instep (NOT calf — atherosclerotic). • Spared kidneys, brain, heart, GI tract (vs atherosclerosis). Workup: • Exclude atherosclerosis: cardiovascular risk factors, lipids, glucose. • Exclude embolic source: ECG, echo (for AF, valvular). • Vasculitis screen: ANCA, ANA, complement, cryoglobulins, antiphospholipid. • Doppler USS, angiography (CT / MR / catheter): typical 'corkscrew' collaterals. • Allen test for distal blood supply.