Fakour Faeze, Fazeli Bahare
Immunology and Microbiology Department, Mashhad Azad University of Medical Sceinces, Mashhad, Iran.
Immunology Research Center, Inflammation and Inflammatory Diseases Division, Immunology Department, School of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.
Vasc Health Risk Manag. 2019 Aug 15;15:317-353. doi: 10.2147/VHRM.S182450. eCollection 2019.
One of the challenges of thromboangiitis obliterans (TAO) management is in the patients whose other vascular beds are involved and it remains a challenge to know whether to pursue invasive procedures or to continue medical treatment for such TAO patients. The aim of this review was to investigate reports of the involvement of the visceral vessels in TAO and the related clinical manifestations, management approaches and outcomes. According to our systematic review, the frequency of published articles, the organs most commonly involved were the gastrointestinal tract, the heart, the central nervous system, the eye, the kidneys, the urogenital system, the mucocutaneous zones, joints, lymphohematopoietic system and the ear. Notably, reports of the involvement of almost all organs have been made in relation to TAO. There were several reports of TAO presentation in other organs before disease diagnosis, in which the involvement of the extremities presented after visceral involvement. The characteristics of the visceral arteries looked like the arteries of the extremities according to angiography or aortography. Also, in autopsies of TAO patients, the vascular involvement of multiple organs has been noted. Moreover, systemic medical treatment could lead to the recovery of the patient from the onset of visceral TAO. This study reveals that TAO may be a systemic disease and patients should be aware of the possible involvement of other organs along with the attendant warning signs. Also, early systemic medical treatment of such patients may lead to better outcomes and reduce the overall mortality rate.
血栓闭塞性脉管炎（TAO）治疗面临的挑战之一在于其他血管床受累的患者，对于此类TAO患者，决定是采取侵入性治疗手段还是继续进行药物治疗仍是一项挑战。本综述的目的是调查TAO患者内脏血管受累的相关报道，以及与之相关的临床表现、治疗方法和治疗结果。根据我们的系统综述，从已发表文章的数量来看，最常受累的器官有胃肠道、心脏、中枢神经系统、眼睛、肾脏、泌尿生殖系统、黏膜皮肤区域、关节、淋巴造血系统和耳朵。值得注意的是，几乎所有器官受累的相关报道都与TAO有关。有几篇报道称，在疾病诊断之前TAO就已累及其他器官，其中肢体受累出现在内脏受累之后。根据血管造影或主动脉造影，内脏动脉的特征与肢体动脉相似。此外，在TAO患者的尸检中，也发现了多个器官的血管受累情况。而且，全身性药物治疗可使内脏TAO患者病情好转。本研究表明，TAO可能是一种全身性疾病，患者应了解其他器官可能受累的情况以及相应的警示信号。此外，对此类患者尽早进行全身性药物治疗可能会取得更好的治疗效果，并降低总体死亡率。
