Thromboangiitis obliterans: an old disease in need of a new look

Almost a century after Buerger's original description of thromboangiitis ob literans, there is still no consensus about diagnostic criteria. The lack o f a universally accepted method of diagnosis causes confusion, and mars res earch efforts. Some authors quote 'hematological disease' as one of the exc lusion criteria. But in most recent reports, suspected Buerger patients did not undergo hematological tests to diagnose or rule out any primary or sec ondary hypercoagulable states. However, immunogenetic studies of Buerger's disease have led to a revived interest in the role of blood coagulation in the pathogenesis of thromboangiitis obliterans. Some association has been s uggested between Buerger's disease and the antiphospholipid syndrome, as we ll as hyperhomocysteinemia. Other thrombophilic conditions have been descri bed anecdotally in patients with Buerger's disease. In view of this develop ing line of investigation, there is a clear need to redefine the diagnostic algorithm and the criteria for diagnosing Buerger's disease. (C) 2000 Else vier Science Ireland Ltd. All rights reserved.