[Thromboangiitis obliterans: an update 2025]

Thromboangiitis obliterans (TAO) is a rare cause of peripheral circulatory disorders and is fundamentally linked to nicotine consumption. Presumably due to the global decline in tobacco consumption, TAO is now rarely encountered even in vascular medicine practice. TAO has a fluctuating course and can present initially with acral necrosis. The application of clinical criteria according to Shionoya and the adequate interpretation of imaging with segmental occlusions and periarterial collaterals are essential for the diagnosis of TAO. Vasculitis, which occurs predominantly in younger men under the age of 45, is undergoing a clinical change and now more frequently affects women, more frequently occurs in patients over the age of 45, less frequently affects multiple extremities, and less frequently presents with thrombophlebitis. Early-onset peripheral artery disease (PAD) should be ruled out in the differential diagnosis. It can be difficult to distinguish cannabis arteritis in cases of simultaneous consumption. The therapeutic pillar of TAO, the etiology of which remains unclear to this day, is the immediate and complete cessation of tobacco use. To avoid amputations, escalating strategies involving systemic administration of prostaglandins, sympathectomy, and endovascular recanalization are often necessary. The prognosis for amputation-free survival is good under these circumstances.