TAO (THROMBO ANGITIS OBLITERANS)
- Affects
- Young male
- Smoker
- Involves
- Medium
- Small sized vessels
- Pathology
- Thrombosis—progressive obliteration of vessels
- PanarteritisPeriarterial fibrosis may involve vein + nerve + lymphatics
- Clinical Features
- Claudication → rest pain
- Gangrene of extremities
- History of
- Thrombophlebitis of superficial and deep veins
- Raynaud'S phenomenon
- Other Examinations
- CVS for embolic manifestations
- Diabetic status
- Description of
- The gangrenous area
- Peripheral pulse chart
- Diagnosed by
- Blood lipid profile + sugar
- Doppler ultrasonography
- Duplex scanning
- Arteriography
- Management
- Cessation of smoking
- Conservative:Vasodilators - doubtful value care of the gangrenous area
- Palliative:Amputate the gangrenous area; lumbar sympathectomy for ulcer
- Curative:ThromboendarterectomyBye-pass surgeryOmental graft
- Gangrenei. DrySlow progressive arterial (putrefactive necrosis) occlusion with normal venous flow.ii. WetSimultaneous occlusion of artery + vein sudden arterial occlusion
- Raynaud's PhenomenonW White color of affected area with blanchingB Blue color due to stagnation of deoxygenated blood.C Red color due to oxygentated blood.
PULSE CHART
1. Dorsalis Pedis | Lateral to extensor hallucis longus tendon at the proximal end of first web space against medial cuneiform bone. |
2. Posterior Tibial | Midway between medial malleolus and tendoachilles, against calcaneum. |
3. Popliteal | Supine position-Knee flexed; felt against tibial condyle Prone position - Knee flexed; felt against femoral condyle. |
4. Femoral Artery | Below mid inguinal point against head of femur with hip joint flexed, abducted and externally rotated. |
5. Radial Pulse | Proximal to the wrist against lower end of radius. |
6. Brachial Pulse | Medial to the biceps tendon against medial humeral condyle. |
7. Axillary | Against humerus head in the axilla. |
8. Subclavian | Supraclavicular fossa in the midclavicular line against first rib. |
9. Common Carotid | At the level of upper border of thyroid cartilage agai nst transvese process of C6 vertebra. |
10. Superficial Temporal | Anterior to the tragus against temporal bone. |
Rest Pain: Severe continuous pain in the limb at rest due to severe ischemia (cry of dying nerve).
Claudication Distance: The patient often complains of pain after walking a distance.
Claudication Grades (Boyd):
G1 | Pain on walking—pain relieved by continued walking. |
G2 | Pain on walking—pain worsened, the patient continues to walk. |
G3 | The pain mostly compels the patient to take rest. |
Buerger's Test: Elevation of the ischemic limb causes marked pallor of limb.
(normal limb—no change even on elevation to 90°)
Buerger's Angle: The angle at which sudden pallor develops.
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