[Thrombangiitis obliterans: diagnosis and therapy in light of new immunological findings].

Thrombangiitis obliterans, a segmental, multilocal, inflammatory disease of the small and medium-sized arteries and veins, is characterized by the relatively juvenile onset of the disease, the peripheral localization of the arterial occlusions and by phlebitis saltans. Other diagnostic criteria are the absence of risk factors typical of atherosclerosis (except smoking), strictly localized occlusion on angiography, phasic clinical course, and exclusion of either collagen disease or essential thrombocytosis. A possible immunopathogenesis for the disease is increasingly favored. In our own study of 33 patients the complement factor C4 was increased in 54.6%, the antielastin antibodies were found at a titre of 1:8 in 57.1% and the immuncomplexes in 23.3%. In only 1 case was the histocompatibility antigen HLA B 12 absent. In view of these immunologic findings and also the fact that phlebitis saltans as a symptom of the disease can be suppressed by salicylates and corticosteroids, but not by anticoagulants, the following therapy is proposed: high doses of acetylsalicylic acid during the acute stage of the illness, or, if this regimen fails, a trial with corticosteroids or immunosuppressive agents.