Thromboangiitis Obliterans

Background
Thromboangiitis obliterans (TAO), an inflammatory vasculopathy also known
as Buerger disease, is characterized by an inflammatory endarteritis that
causes a prothrombotic state and subsequent vaso-occlusive phenomena.
The inflammatory process is initiated within the tunica intima. It
characteristically affects small and medium-sized arteries as well as veins of
the upper and lower extremities. The condition is strongly associated with
heavy tobacco use, and disease progression is closely linked to continued
use. (See Pathophysiology and Etiology.)
Patients often present with moderate-to-severe claudication that can quickly
progress to critical limb ischemia featuring rest pain or tissue loss. Features
of acute limb ischemia (eg, pain, paresthesia, palor, mottling, poikilothermia,
paresis, and pulselessness) are common signs and symptoms encountered
in the emergency setting. [1, 2, 3, 4] (See Presentation.)
Pharmacologic therapy is generally ineffective; abstinence from tobacco is
the only measure known to prevent disease progression. (See Treatment.)
Given the arteritis of the small and medium-sized vessels, surgical or
endovascular revascularization may not be possible, because of the
absence of a distal target for revascularization. As the disease evolves,
amputation may be the only viable option.

Pathophysiology and Etiology

As noted, the development of TAO is strongly associated with heavy use of
tobacco, and the progression of the disease is closely linked to continued
use.
A few observations suggest the existence of an immunologic phenomenon
leading to vasodysfunction and inflammatory thrombi. Patients with TAO
exhibit hypersensitivity to intradermally injected tobacco extracts, increased
cellular sensitivity to collagen types I and III, elevated serum anti–
endothelial cell antibody titers, and impaired peripheral endothelium-
dependent vasorelaxation. They also show a higher prevalence of human
leukocyte antigen (HLA)–A9, HLA-A54, and HLA-B5, suggesting a genetic
component to the disease.

Source : https://emedicine.medscape.com/article/460027-overview#a4