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Clinical, arteriographic and histopathologic analysis of 13 patients with thromboangiitis obliterans and coronary

Christiane A Nobre, Walber P Vieira, Francisco E S da Rocha

    The Israel Medical Association Journal : IMAJ
    |August 30, 2014
    PubMed

    Insights

    Thromboangiitis obliterans (TAO), or Buerger's disease, rarely affects the coronary arteries, even in smokers. Young patients with coronary artery disease (CAD) and smoking as a primary risk factor should be evaluated for TAO.

    Area of Science:

    • Vascular Surgery
    • Cardiology
    • Pathology

    Background:

    • Thromboangiitis obliterans (TAO), also known as Buerger's disease, is a rare inflammatory condition affecting small and medium-sized arteries, predominantly in the limbs.
    • While smoking is a known risk factor for TAO and arteriosclerosis, its association with coronary artery disease (CAD) is infrequently reported.

    Observation:

    • A literature review identified 12 cases of TAO with coronary involvement between 1966 and 2012.
    • An additional case presented with central nervous system, myocardial, and large-artery involvement, bringing the total to 13 cases.
    • Common symptoms included lower limb claudication and acute thoracic pain.

    Findings:

    • Histological examination revealed thrombosis with an intact internal elastic lamina and granulocytic infiltration of the intima.
    • Coronary angiography demonstrated significant involvement of the left anterior descending and right coronary arteries.
    • Treatment strategies comprised coronary bypass, angioplasty, smoking cessation, and anticoagulation, with a 50% complete therapeutic response rate.

    Implications:

    • This review highlights the uncommon clinical association between TAO and CAD.
    • Young patients (<40 years) presenting with CAD and significant smoking history, but lacking other major cardiovascular risk factors, warrant investigation for Buerger's disease.

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