Joviliano Edwaldo Edner, Dellalibera-Joviliano Renata, Dalio Marcelo, Evora Paulo Rb, Piccinato Carlos E
Department of Surgery and Anatomy, Ribeirão Preto Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Int J Angiol. 2009 Fall;18(3):119-25. doi: 10.1055/s-0031-1278337.
Thromboangiitis obliterans (TAO) is a segmental inflammatory occlusive disorder that affects small- and medium-sized arteries, and arm and leg veins of young smokers. Several different diagnostic criteria have been offered for the diagnosis of TAO. Clinically, it manifests as migratory thrombophlebitis or signs of arterial insufficiency in the extremities. It is characterized by highly cellular and inflammatory occlusive thrombi, primarily of the distal extremities. Thromboses are often occlusive and sometimes display moderate, nonspecific inflammatory infiltrate, consisting mostly of polymorphonuclear leukocytes, mononuclear cells and rare multinuclear giant cells. The immune system appears to play a critical role in the etiology of TAO. However, knowledge about immunological aspects involved in the progression of vascular tissue inflammation, and consequently, the evolution of this disease, is still limited. There are several studies that suggest the involvement of genetic factors and results have shown increasing levels of antiendothelial cell antibodies in patients with active disease. Vasodilation is impaired in patients with TAO. TAO disorder may actually be an autoimmune disorder, probably initiated by an unknown antigen in the vascular endothelium, possibly a component of nicotine. There are various therapies available for treatment of TAO, but the major and indispensable measure is smoking cessation. Except for discontinuation of tobacco use, no forms of therapy are definitive. Sympathectomy, cilostazol and prostaglandin analogues (prostacyclin or prostaglandin E) have been used in specific conditions. Recently, therapeutic angiogenesis with autologous transplantation of bone marrow mononuclear cells has been studied in patients with critical limb ischemia.
血栓闭塞性脉管炎（TAO）是一种节段性炎症性闭塞性疾病，影响年轻吸烟者的中小动脉以及手臂和腿部静脉。目前已提出多种不同的诊断标准用于TAO的诊断。临床上，它表现为游走性血栓性静脉炎或四肢动脉供血不足的体征。其特征是形成高度细胞化和炎症性的闭塞性血栓，主要位于四肢远端。血栓通常为闭塞性，有时显示中度、非特异性炎症浸润，主要由多形核白细胞、单核细胞和罕见的多核巨细胞组成。免疫系统似乎在TAO的病因中起关键作用。然而，关于血管组织炎症进展所涉及的免疫方面以及该疾病的演变，目前的认识仍然有限。有几项研究表明遗传因素的参与，并且结果显示活动性疾病患者的抗内皮细胞抗体水平升高。TAO患者存在血管舒张功能受损。TAO疾病实际上可能是一种自身免疫性疾病，可能由血管内皮中的未知抗原引发，可能是尼古丁的一种成分。有多种治疗TAO的方法，但主要且必不可少的措施是戒烟。除了停止使用烟草外，没有任何形式的治疗是确定有效的。交感神经切除术、西洛他唑和前列腺素类似物（前列环素或前列腺素E）已在特定情况下使用。最近，对于严重肢体缺血患者，已经研究了自体骨髓单个核细胞移植的治疗性血管生成。
