The Angiography Pattern of Buerger’s Disease: Challenges and Recommendations


Fazeli B., Poredos P., Liew A., Stephen E., Bashar A. H. M., Kozak M., ...More

Journal of Clinical Medicine, vol.14, no.14, 2025 (SCI-Expanded, Scopus) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 14 Issue: 14
  • Publication Date: 2025
  • Doi Number: 10.3390/jcm14144841
  • Journal Name: Journal of Clinical Medicine
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, Directory of Open Access Journals
  • Keywords: angiography, arteriography, Buerger’s disease, diagnosis, peripheral arterial disease, thromboangiitis obliterans, vasculitis
  • Gazi University Affiliated: Yes

Abstract

In 2023, the VAS international working group on Buerger’s Disease (BD) recommended two diagnostic criteria based on a prior Delphi study: “definitive” and “suspected”. The “definitive” criteria are history of smoking, typical angiography, and typical histopathological features. All three features are mandatory to confirm a “definitive” diagnosis of BD. The conundrum is—what features should be considered typical of BD angiography? According to this review, segmental occlusion of infrapopliteal arteries, corkscrew collaterals that appear to continue the occluded arterial segment (Martorell’s sign) or bypass the segmental occlusion, absence of atherosclerotic plaque or aneurysm could differentiate BD from ASO. Hence, for “typical” BD angiography, these manifestations should certainly be considered. However, data for differentiating angiography patterns of BD from the small- and medium-sized vasculitis including Behcet’s disease, scleroderma, hepatitis associated vasculitis, and anti-phospholipid syndrome are limited. Further studies for investigating the angiography pattern in BD patients in early and late presentation of BD, particularly in the patients with long-term follow up, are highly recommended.