Which criteria are used to support or contest the diagnosis of thromboangiitis obliterans (TAO) (Buerger disease)?

Updated: Jul 27, 2020
  • Author: Naiem Nassiri, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

In 1996, Papa et al proposed a point-scoring system to support or contest the diagnosis of TAO on the basis of the following criteria [11] :

  • Distal extremity (feet, toes, hands, or fingers) involvement
  • Onset before age 45 years
  • Tobacco use
  • Exclusion of atherosclerosis or proximal source of emboli
  • Absence of a hypercoagulable state
  • Absence of definable arteritis (eg, progressive systemic sclerosis or giant-cell arteritis)
  • Classic arteriographic findings
  • Involvement of digital arteries of finger or toes
  • Segmental involvement (ie, “skip areas”)
  • “Corkscrew collaterals”
  • No atherosclerotic changes
  • Classic histopathologic findings
  • Inflammatory cellular infiltrate within thrombus
  • Intact internal elastic lamina
  • Involvement of surrounding venous tissues

The scoring system is applied as indicated in Table 1 and Table 2 below.

Table 1. Scoring System for Diagnosis of Thromboangiitis Obliterans [11] (Open Table in a new window)

Positive Criterion

Positive Points

Age at onset

<30 y (+2)

30-40 y (+1)

Foot intermittent claudication

Present (+2)

By history only (+1)

Upper extremity

Symptomatic (+2)

Asymptomatic (+1)

Migrating superficial thrombophlebitis

Present (+2)

By history only (+1)

Raynaud phenomenon

Present (+2)

By history only (+1)

Angiography; biopsy

If typical, both (+2)

Either(+1)

Negative Criterion

Negative Points

Age at onset

45-50 y (−1)

>50 y (−2)

Sex; smoking

Female (−1)

Nonsmoker (−2)

Location

Single limb (−1)

No lower extremity involved (−2)

Absent pulses

Brachial (−1)

Femoral (−2)

Arteriosclerosis, diabetes, hypertension, hyperlipidemia

Discovered 5.1-10 y after diagnosis (−1)

Discovered 2.1-5 y later (−2)

 

Table 2. Numerical Scores Defining Probability of Diagnosis of Thromboangiitis Obliterans (Open Table in a new window)

Score

Probability of Diagnosis

0-1

Diagnosis excluded

2-3

Diagnosis suspected (low probability)

4-5

Diagnosis probable (medium probability)

≥6

Diagnosis definite (high probability)


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