cardiovascular disorders
Thromboangiitis Obliterans
Symptoms and Signs of Thromboangiitis Obliterans
Symptoms and signs are those of arterial ischemia and Superficial Venous Thrombosis . Some patients have a history of migratory phlebitis, usually in the superficial veins of a foot or leg. Onset is gradual, starting in the most distal vessels of the upper and lower extremities with coldness, numbness, tingling, or burning. These symptoms may develop before objective evidence of disease. Raynaud Syndrome is common. Intermittent claudication occurs in the affected extremity (usually in the arch of the foot or in the leg; rarely in the hand, arm, or thigh) and may progress to rest pain. Frequently, if pain is severe and persistent, the affected leg feels cold, sweats excessively, and becomes cyanotic, probably because of sympathetic nerve overactivity. Later, ischemic ulcers develop in most patients and may progress to gangrene. Pulses are impaired or absent in one or more pedal arteries and often at the wrist. In young men who smoke and have extremity ulcers, a positive Allen test (the hand remains pale after the examiner simultaneously compresses the radial and ulnar arteries, then alternately releases them) suggests the disorder. Pallor with elevation and rubor with dependency frequently occur in affected hands, feet, or digits. Ischemic ulceration and gangrene, usually of one or more digits, may occur early in the disorder but not acutely. Noninvasive tests show greatly decreased blood flow and pressure in the affected toes, feet, and fingers. 