Modern aspects of the problem of obliterating thrombangiitis

To present some pathogenesis, diagnostics and treatment of thromboangiitis obliterans (TAO) discussion items in accordance with the contemporary views on the nomenclature, classification, pathogenesis and treatment of rheumatic diseases. Materials and methods. 115 patients with thromboangiitis obliterans under observation in Interregional Consultative Center for the patients with systemic rheumatic diseases were examined. The complex analysis of peripheral circulation was carried out by ultrasonic scintiangiography. The methods of study included: morphological analysis of biopsy, autopsic and operating material by histochemical methods; immunofluorescent method was used for detecting the immune complexes. In 224 patients with systemic vasculitides (SV) serological markers, including the wide spectrum of autoantibodies, C-reactive protein, complement, von Willebrand factor antigen as a marker of defeat of vascular wall were detected. Results. Most diagnostically significant criteria were: age younger than 45 years, male sex, smoking, distal vascular lesions of the extremities and confirmation of thromboangiitis obliterans by musculocutaneous biopsy. The involvement of small- and medium-sized arteries and also thrombophlebitis and phlebemphraxis were typical. Reliable diagnosis could have been considered when scintiangiography data that testified about the contraction or occlusion of distal arteries of extremities, and the results of biopsy were presented. Morphological substratum was a destructive-productive or productive thrombovasculitis of middleand small-sized arteries and veins. Necrotic destructive-infiltrative and destructive-proliferative arteriitis, accompanied by fibrinoid necrosis of the arterial wall and by its infiltration with neutrophils were revealed with the productive. The thromboses were revealed with these arteriitis more frequently, and in the wall of such arteries immune complexes were observed. Ischemic manifestations were connected not only with arterial stenosis, but also with microangiosclerosis. Differential diagnostic signs of atherosclerosis were represented. Involving of small- and middle-sized arteries was typical for thromboangiitis obliterans and large- and middle- sized arteries — for atherosclerosis. The thrombophlebitis and phlebothrombosis were characteristic for TAO. No specific laboratory tests were available to confirm TAO diagnosis. It should be noted the specific diagnostic tests and positive serological markers, characteristic for other SV nosologic forms were absent. Some questions of nosologic specification, pathogenesis and principles of therapy were discussed. It should also be noted that the spectrum of TAO interpretation changed since the beginning of the XXI century. The disease requires multidistsiplinary approach both in diagnostics and refinement of nosologic belonging, pathogenesis and designation of pathogenetic therapy.

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