Mehr als 115 Jahre nach der Erstbeschreibung bleibt die Thrombangiitis obliterans
eine bis heute rätselhafte Erkrankung. Obgleich der Nikotinkonsum für das Auftreten
und den klinischen Verlauf eine zentrale Rolle spielt, bleibt die Ursache der nicht
atherosklerotischen Arteriopathie bislang unklar. Der in den letzten Dekaden vollzogene
Wandel von der Epidemiologie über das klinische Spektrum bis hin zur Therapie ist
Gegenstand dieses Beitrages.
Abstract
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.
Schlüsselwörter
Thrombangiitis obliterans - diagnostische Kriterien - klinischer Wandel - Differentialdiagnose
- Therapie
Keywords
Thrombangiitis obliterans - diagnostic criteria - clinical change - differential diagnosis
- therapy
