Buerger's disease or thromboangeitis obliterans.

Purpose. -To review clinical data, pathophysiology and treatment of thromboangeitis (Buerger's disease). Data synthesis. -Buerger's disease or thromboangeitis obliterans (TAO) is an obliterative vascular disease that affects medium and small sized arteries as well as superficial veins. Young males and smokers are preferentially afflicted with the disease. TAO accounts for 0.5 to 5% of occlusive vascular disease. Though TAO has a world-wide distribution, it can be found with greater prevalence in Eastern Europe, the Mid-East, Asia, and Southeast Asia. Women account for 10 to 20% of the patients and 5 to 10% are more than 60-years-old. Approximately 95% are smokers and disease activity is strongly associated with the use of tobacco. The pathogenesis is poorly understood and most hypotheses are controversial. There is no specific marker of the disease and the diagnosis is based an clinical and angiographic criteria. The disease spontaneously leads to tissue loss and major amputations. This can generally be avoided by discontinuing smoking. Included hypervolemia and prostacyclins are effective treatments of critical limb ischemia in TAO. Conclusion. -If pathophysiology is still poorly understood, spontaneous evolution can be avoided by stopping tobacco and prostacyclin. (C) 1998, Elsevier, Paris.