Thromboangitis Obliterans (TAO) / Buerger’s Disease

It is the thrombosis and inflammation of the arterial wall with the occlusion of the lumen of the vessels

This is characterized by….

  • Occlusive disease of small and medium sized arteries (plantar, tibial, radial)
  • Thrombophlebitis of the superficial or deep veins 
  • Raynaud’s syndrome

Cause Of TAO

The cause is unknown

Commonly occurs in male smokers under the age of 40 years in low socioeconomic status

TAO initially affects the toe vessels
Gradually involves the plantar and tibial arteries
Causes thrombophlebitis of the superficial and deep veins
Also causes segamental inflammatory and thrombotic processes of the peripheral arteries and veins,
mostly in the lower limbs
Occlusion of the vessels
Ischemia, ulceration, gangrene

Histologically, there are inflammatory changes in the walls of arteries and veins,leading to thrombosis

Management Of Thromboangitis Obliterans

Patient profile

  1. Age : Under 40 years
  2. Males smokers are commonly affected
  3. Manual labourers are more affected
  4. Bore footed are more affected
  5. Genetic predisposition may be present (DM, heart disease)

Clinical features

  1. Intermittent claudication
  2. Rest pain
  3. Tissue necrosis leading to gangrene
  4. Coldness, numbness, paraesthesia and change of colour of limbs


  1. Skin : Dry, shriveled, mummified, blackened, greasy to touch (Dry gangrene)
  2. Ulcer or gangrene is present
  3. Loss of hair
  4. Trophic changes of nail (Become brittle, transverse ridges)
  5. Muscle wasting
  6. Shiny skin
  7. Reduced skin thickness
  8. Diminished sensation
  9. Diminished movements
  10. Decreased or absent arterial pulsation
  11. Delayed venous filling
  12. Areas is cold in respect to the other areas


  1. No specific investigations 


  1. Avoid smoking
  2. Nutrition supplementation
  3. Care of the limbs
  4. Wearing soft shoes and socks
    • Keeping the feet dry
    • Careful pairing of toe nails
    • Regular exercise within the limit of claudication pain
  5. Buerger’s exercise
    • Rise the limbs for 2 mins and then hang it for next 3 mins for 30 mins for 2 – 3 times a day
  6. Medical treatment
    • Pentoxifylline to increase microcirculation by reducing blood viscosity
    • Cilostazol
    • Low dose aspirin
    • Analgesics for pain
    • Broad spectrum antibiotics
  7. Specific treatment
    • Bilateral lumber sympathectomy
    • It causes cutaneous vasodilation and improve cutaneous circulation and rest pain
    • It does not improve intermittent claudication
    • If it fails amputation
  8. If ulcer present – Treatment for the ulcer
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