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International Angiology 2021 October;40(5):395-408

DOI: 10.23736/S0392-9590.21.04712-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Milestones in thromboangiitis obliterans: a position paper of the VAS-European independent foundation in angiology/vascular medicine

Bahare FAZELI ¹, Pavel POREDOS ² ✉, Malay PATEL ³, Peter KLEIN-WEIGEL ⁴, Mariella CATALANO ⁵, Edwin STEPHEN ⁶, Mussaad M. AL SALMAN ⁷, Louay ALTARAZI ⁸, Abul H. BASHAR ⁹, Benjamin CHUA ¹⁰, Mary P. COLGAN ¹¹, Ivan CVJETKO ¹², Sanjay DESAI ¹³, Evangelos P. DIMAKAKOS ¹⁴, Dilek ERER ¹⁵, Katalin FARKAS ¹⁶, Gerry R. FOWKES ¹⁷, Grigorios GEROTZIAFAS ¹⁸, Emad HUSSEIN ¹⁹, Mihai IONAC ²⁰, Takehisa IWAI ²¹, Oguz KARAHAN ²², Endre KOLOSSVARY ¹⁶, Albert KOTA ²³, Matija KOZAK ²⁴, Knut KROGER ²⁵, Prabhu P. KUMAR ²³, Aaron LIEW ²⁶, Rafal MALECKI ²⁷, Mohammad H. NAJAFI ²⁸, Dan-Mircea OLINIC ²⁹, Sandeep R. PANDEY ³⁰, Zsolt PECSVARADY ³¹, Hassan RAVARI ³²,Vimalin SAMUEL ²³, Gerit SCHERNTHANER ³³, Dheepak SELVARAJ ²³, Nuttawut SERMSATHANASAWADI ³⁴, Hiva SHAREBIANI ¹, Agata STANEK ³⁵, Andrzej SZUBA ²⁷, Hossein TAHERI ³⁶, Jean C. WAUTRECHT ³⁷, Mustafa HAKAN ZOR ¹⁵

¹ School of Medicine, Division of Inflammation and Inflammatory Diseases, Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; ² Slovenia Academic Research Center, Slovenian Medical Academy, Medical Association of Slovenia and SMA, Ljubljana, Slovenia; ³ Department of Vascular Surgery, Apollo-CVHF Hospital, Ahmedabad, India; ⁴ Clinic of Angiology, Zentrum für Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany; ⁵ Unit of Angiology, Department of Biomedical Science, Research Center on Vascular Disease, L. Sacco Hospital, University of Milan, Milan, Italy; ⁶ Department of Vascular Surgery, Sultan Qaboos University Hospital, Muscat, Oman; ⁷ Division of Vascular Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia; ⁸ Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria; ⁹ National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh; ¹⁰ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; ¹¹ Department of Vascular Surgery, St. James’s Hospital/Trinity College Dublin, Dublin, Ireland; ¹² Department of Vascular Surgery, University Hospital Mekur, Zagreb, Croatia; ¹³ Department of Vascular and Endovascular Surgery, Ramaiah Medical College Hospital, Bangalore, India; ¹⁴ Unit of Vascular Surgery, Third Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece; ¹⁵ Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey; ¹⁶ Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary; ¹⁷ Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, UK; ¹⁸ Hematology and Thrombosis Center, Hôpitaux Universitaires de l’Est Parisien, Assistance Publique Hôpitaux de Paris, Faculty of Medicine, Hôpital Tenon, Sorbonne University, Paris, France; ¹⁹ Department of Vascular Surgery, Ain Shams University, Cairo, Egypt; ²⁰ Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; ²¹ Unit of Periodontology, Division of Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan; ²² Medical School, Department of Cardiovascular Surgery, Alaaddin Keykubat University, Alanya/Antalya, Turkey; ²³ Department of Vascular Surgery, Christian Medical College, Vellore, Tamil Nadu, India; ²⁴ Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia; ²⁵ Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany; ²⁶ Portiuncula University Hospital, Soalta University Health Care Group, National University of Ireland Galway (NUIG), Galway, Ireland; ²⁷ Department of Angiology, Systemic Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland; ²⁸ Unit of Tehran Medical, Department of Cardiology, Azad University, Tehran, Iran; ²⁹ Medical Clinic N.1, University of Medicine and Pharmacy, Cluj-Napoca, Romania; ³⁰ Department of Vascular and Endovascular Surgery, Annapurna Hospital, Kathmandu, Nepal; ³¹ Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary; ³² Vascular Surgery Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; ³³ Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria; ³⁴ Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand;35 Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland; ³⁶ Surgery Department, Farabi Hospital, Mashhad, Iran; ³⁷ Service de Pathologie Vasculaire, ERASME Hospital, Université Libre de Bruxelle (ULB), Brussels, Belgium

Even today thromboangiitis obliterans has disease features that remain misunderstood or underappreciated. The epidemiology, etiology and pathophysiology of the disease are still unclear. Biomarkers and disease activity markers are lacking, thus clinical assessment is difficult. We are still struggling to establish unique diagnostic, staging and treatment criteria. This is an academic-collaborative effort to describe the pathophysiology, the clinical manifestations, the diagnostic approach, and the challenges of management of patients with TAO. A systematic search for relevant studies dating from 1900 to the end of 2020 was performed on the PubMed, SCOPUS, and Science Direct databases. Given the intriguing nature of presentation of TAO, its management, to some extent is not only different in different regions of the world but also varies within the same region. Following this project, we discovered ambiguity, overlap and lack of clear-cut criteria for management of TAO. An international group of experts however came to one conclusion. They all agree that management of TAO needs a call for action for a renewed global look with multi-center studies, to update the geographical distribution of the disease and to establish a unique set of diagnostic criteria and a consensus-based guideline for best treatment based on current evidence.

KEY WORDS: Thromboangiitis obliterans; Cardiology; Blood vessels