Thromboangiitis Obliterans

Usually, symptoms of a reduced blood supply to the arms or legs develop gradually. Symptoms include

These abnormal sensations start at the fingertips or toes and progress up the legs or arms. The legs are affected more often than the arms. People may feel abnormal sensations before their doctor sees any skin changes indicating an inadequate blood supply (ischemia) or gangrene. Raynaud syndrome Raynaud Syndrome Raynaud syndrome, a functional peripheral arterial disease, is a condition in which small arteries (arterioles), usually in the fingers or toes, narrow (constrict) more tightly than normal in... read more and muscle discomfort during exertion (intermittent claudication Symptoms ) may develop. Cramps occur in the calf muscles or feet if the legs are affected and in the hands or forearms if the arms are affected.

As the disease progresses, cramps become more painful and last longer. Late in the disease, skin ulcers, gangrene, or both may appear, usually on one or more toes or fingers. The foot or hand feels cold and may turn bluish (cyanosis), probably because blood flow is greatly reduced.

Some people with thromboangiitis obliterans also have episodes of inflammation in the veins (migratory phlebitis Superficial Venous Thrombosis Superficial venous thrombosis is inflammation and clotting in a superficial vein, usually in the arms or legs. The skin over the vein becomes red, swollen, and painful. Doctors examine the area... read more ), usually in the superficial veins.

Usually, doctors suspect thromboangiitis obliterans on the basis of symptoms and results of the physical examination. In most people, the pulse is weak or absent in one or more arteries of the feet or wrists. Often, the affected hands, feet, fingers, or toes become pale when raised above the heart and red when lowered. Ultrasonography detects a substantial decrease in blood pressure and blood flow in the affected feet, toes, hands, and fingers. Blood tests and imaging to exclude other causes of decreased blood flow (such as vessel inflammation or vasculitis and blood clots from the heart) are done.

Angiography Angiography In angiography, x-rays are used to produce detailed images of blood vessels. It is sometimes called conventional angiography to distinguish it from computed tomography (CT) angiography and magnetic... read more can detect specific patterns of narrowing and thus can help confirm the diagnosis.

Sometimes a biopsy (removal of a tissue sample for examination under a microscope) of the affected artery or referral to a specialist is needed to confirm the diagnosis of thromboangiitis obliterans.

Stopping smoking Smoking Cessation While often very challenging, quitting smoking is one of the most important things smokers can do for their health. Quitting smoking brings immediate health benefits that increase over time... read more immediately is essential, or symptoms will relentlessly worsen. Amputation is then likely to become necessary.

Avoiding exposure to cold, which causes blood vessels to narrow (constrict) is helpful.

Avoiding certain drugs and medications is also helpful. Drugs and medications to avoid include those that cause blood vessels to constrict (such as ephedrine, pseudoephedrine, or phenylephrine, which are components of some sinus congestion and cold remedies), cocaine and amphetamines, and those that increase the tendency of blood to clot (such as estrogen in birth control pills or hormone replacement therapy).

Preventing injury to the affected leg or arm is important. People should take care to avoid burns and injuries due to cold or minor surgery (such as trimming calluses). Corns and calluses should be treated by a podiatrist. Wearing shoes that fit well and have wide toe spaces can help prevent injury to the feet.

Medications, that dilate blood vessels, such as iloprost, may help heal ulcers and reduce pain in people who quit smoking but still have blocked arteries. Other medications, such as pentoxifylline and calcium channel blockers, may be tried to help open blood vessels but are probably not very effective.

Surgery may be done to cut certain nearby nerves (a procedure called sympathectomy) and prevent blood vessels from constricting. These procedures are seldom done because they usually improve blood flow only temporarily.

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.