Criteria

Shionoya clinical criteria of diagnosis[31]​​

All 5 criteria must be met:

  • Smoking history

  • Onset before the age of 50 years

  • Infrapopliteal arterial occlusive lesions

  • Upper limb involvement of phlebitis migrans (also known as thrombophlebitis migrans)

  • Absence of atherosclerotic risk factors aside from smoking.

These criteria were described in 1998 to make the diagnosis of Buerger's disease.[31]​ However, patients >50 years of age have been given the diagnosis. Probable Buerger's disease is considered when all but the fourth criterion are met.

Point scoring system of diagnosis (Papa criteria)[32]

Positive points:

  • Age at onset: less than 30 years (+2) / 30-40 years (+1)

  • Foot intermittent claudication: present (+2) / by history (+1)

  • Upper extremity: symptomatic (+) / asymptomatic (+1)

  • Migrating superficial vein thrombosis: present (+2) / by history only (+1)

  • Raynaud colour changes: present (+2) / by history only (+1)

  • Angiography; Biopsy: if typical, both (+2) / either (+1)

Negative points:

  • Age at onset: 45-50 years (-1) / >50 years (-2)

  • Sex, smoking: female (-1) / non-smoker (-2)

  • Location: single limb (-1) / no lower extremity involved (-2)

  • Absent pulses: brachial (-1) / femoral (-2)

  • Arteriosclerosis, diabetes mellitus, hypertension, hypercholesterolaemia: discovered after diagnosis 5.1-10 years (-1) / 2.1-5 years (-2)

Total of points defines the probability of the diagnosis:

  • 0-1 points: Diagnosis excluded

  • 2-3 points: Suspected, low probability

  • 4-5 points: Probable, medium probability

  • ≥6 points: Definite, high probability

International Consensus of VAS[33]

The three main features for definitive diagnosis:

  • History of smoking

  • Typical angiographic features (normal proximal arterial structure, absence of atherosclerotic plaque, lack of microaneurysm, infra-popliteal arterial occlusion, corkscrew collaterals, and skip lesion)

  • Typical histopathological features (particularly, intact internal elastic lamina, Infiltration of polymorphonuclear inflammatory cells in all small and medium-sized vessels’ wall layers)

Suspected Buerger’s disease if one major feature listed above plus four or more of the following minor criteria are present:

  • Disease onset before the age of 45 years

  • Ischaemic involvement of lower limbs (absent DP or PT, ABPI <0.9 or TBI <0.75)

  • Ischaemic involvement of one or both upper limbs (positive Allen’s test, absence of radial artery pulse, or Raynaud’s phenomenon)

  • Thrombophlebitis migrans

  • Red-blue shade of purple discolouration on oedematous toes or fingers

Olin criteria[34]

  • Age under 45 years

  • Current or recent history of tobacco use

  • Presence of distal-extremity ischaemia indicated by claudication, pain at rest, ischaemic ulcers or gangrenes and documented by non-invasive vascular testing

  • Exclusion of autoimmune diseases, hypercoagulable states and diabetes mellitus

  • Exclusion of a proximal source of emboli by echocardiography or arteriography

  • Consistent arteriographic findings in the clinically involved and non-involved limbs

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