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Thromboangiitis Obliterans (TAO)

Clinical Subject Page

Thromboangiitis Obliterans (TAO)

Affects the blood vessels of the arms and legs.

Also called

Buerger disease

ICD-10

I73.1

Specialty

Cardiology

Onset

Chrnoic

Reviewed

July 2026

On This Page

Overview

Thromboangiitis Obliterans (TAO) , also called Buerger disease, is a disease that causes inflammation and blockage of small and medium-sized blood vessels, mainly in the hands and feet. It is strongly linked to tobacco use (smoking, chewing tobacco, or vaping).

Etiology & Risk Factors

-Etiology

  • The exact cause is unknown.
  • Tobacco use triggers inflammation and blockage of blood vessels in susceptible people.

Risk Factors

  • Tobacco use (most important risk factor):
    • Smoking
    • Chewing tobacco
    • Vaping
  • Male sex (more common in men)
  • Age younger than 45 years

Pathophysiology

Tobacco use (smoking/chewing/vaping) → Inflammation of small & medium blood vessels → Inflammatory thrombus (blood clot) forms → Blood vessel blockage (vaso-occlusion) → Reduced blood flow (ischemia) → Pain, ulcers, gangrene → Possible amputation

Clinical Presentation

    • Pain while walking (intermittent claudication)
    • Cold, pale fingers or toes (Raynaud phenomenon)
    • Pain at rest (late stage)
    • Weak or absent pulses
    • Painful, red superficial veins (migratory superficial thrombophlebitis)
    • Finger or toe ulcers
    • Gangrene (severe cases)
    • Usually affects both hands and/or feet

History Taking

  • How long have you used tobacco?
  • Do you have pain in your legs or feet while walking?
  • Do you have pain in your fingers or toes at rest?
  • Do your fingers or toes become cold or change color?
  • Have you noticed any sores or ulcers on your fingers or toes?
  • Have you had blackening (gangrene) of any finger or toe?
  • Have you had painful, red, swollen veins?
  • Are both hands or feet affected?
  • When did your symptoms start?

Physical Examination

  • Cool hands or feet
  • Pale or bluish fingers/toes
  • Weak or absent distal pulses
  • Finger or toe ulcers
  • Gangrene of fingers or toes
  • Tender, red superficial veins (superficial thrombophlebitis)
  • Signs of Raynaud phenomenon (color changes in fingers/toes)

Investigations

    • CBC
    • ESR and CRP (usually normal)
    • Coagulation studies
    • Autoantibody tests (e.g., ANA, RF) to exclude other diseases
    • Ankle–Brachial Index (ABI) (may be decreased)
    • Angiography (best imaging test) – shows distal vessel blockage and corkscrew collateral vessels
    • Echocardiography (if an embolic source is suspected)
    • Biopsy (only if the presentation is atypical)

Diagnosis

  • History of tobacco use
  • Typical signs of distal limb ischemia
  • Exclude other causes (e.g., peripheral artery disease, diabetes, vasculitis)
  • Angiography supports the diagnosis (shows distal vessel occlusion with corkscrew collateral vessels)
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Management

  • 1. Stop tobacco completely (Most important)
  • Stop smoking, chewing tobacco, and vaping.
  • Avoid nicotine products (e.g., nicotine patches or gum).
  • 2. Supportive care
  • Protect hands and feet from cold and injury.
  • Keep ulcers clean and perform regular wound care.
  • Treat infections with antibiotics if needed.
  • 3. Medications
  • Iloprost to reduce pain and improve ulcer healing.
  • Calcium channel blockers (e.g., nifedipine, amlodipine) may be used.
  • 4. Surgery
  • Debridement for infected ulcers.
  • Amputation if gangrene develops.
  • Revascularization is rarely possible.

Complications

  • Chronic limb ischemia
  • Digital ulcers (fingers or toes)
  • Gangrene
  • Autoamputation of digits
  • Surgical amputation
  • Wound infection (infected ulcers)

Prognosis

  • Good if the patient completely stops all tobacco use.
  • Symptoms may improve, and the risk of amputation decreases with early tobacco cessation.
  • Poor if tobacco use continues.
  • Ongoing tobacco use can lead to progressive ischemia, ulcers, gangrene, and amputation.

Key Points / Clinical Pearls

  • Thromboangiitis Obliterans (Buerger disease).
  • Inflammatory, nonatherosclerotic disease of small and medium-sized blood vessels.
  • Tobacco use is the major risk factor.
  • Usually affects adults younger than 45 years.
  • Common symptoms: claudication, Raynaud phenomenon, rest pain, ulcers, and gangrene.
  • Physical signs: cool limbs, weak/absent pulses, ulcers, gangrene.
  • Diagnosis is mainly clinical and supported by angiography.
  • Complete tobacco cessation is the most important treatment.
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  • Olin JW, Shih A. Thromboangiitis Obliterans (Buerger's Disease). Curr Opin Rheumatol. 2006;18:18-24. PMC1523324.
  • Rivera-Chavarria IJ, Brenes-Gutierrez JV. Thromboangiitis Obliterans (Buerger's Disease). Ann Med Surg. 2016;7:79-82. PMC4633979.
  • Vijayakumar A, Tiwari R, Kumar Prabhuswamy V. Thromboangiitis Obliterans (Buerger's Disease): Current Practices. Int J Inflam. 2013;2013:156905. PMC3676975.
  • MedlinePlus, National Library of Medicine (NIH). Buerger Disease: Medical Encyclopedia.