Last reviewed: November 2017
Last updated: August  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors

Other diagnostic factors

  • paraesthesias/cold sensation/cyanosis in limb or finger
  • ulceration/gangrene
  • claudication
  • rest pain
  • superficial thrombophlebitis
  • cold limb or finger
  • pale limb or finger
  • absence of distal pulses
  • positive Allen test
  • joint arthritis
  • duration of joint symptoms up to 2 weeks

Risk factors

  • smoking
  • age <40 years
  • region of origin: southeast Mediterranean, Middle East, and Far East
  • male sex
  • periodontal infection
  • human leukocyte antigen (HLA) haplotypes

Diagnostic investigations

1st investigations to order

  • blood glucose
  • urea
  • serum creatinine
  • FBC with differential
  • coagulation screen
  • thrombophilia screen
  • CRP
  • ESR
  • arterial Doppler
Full details

Investigations to consider

  • anti-nuclear antibody
  • rheumatoid factor
  • anti-neutrophilic cytoplasmic antibody (ANCA)
  • complement levels
  • anti-centromere antibody
  • topoisomerase I antibodies (Scl-70)
  • echocardiogram
  • arterial duplex
  • digital subtraction angiography
  • anti-cardiolipin antibodies
Full details

Emerging tests

  • CT angiography
  • magnetic resonance angiography
  • tissue biopsy
  • genetic testing
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Matthew J. Metcalfe

Consultant Vascular Surgeon

Lister Hospital

East and North Hertfordshire NHS Trust

Hertfordshire

UK

Disclosures

MJM declares that he has no competing interests.

Alun H. Davies

Professor of Vascular Surgery and Honorary Consultant Surgeon

Department of Vascular Surgery

Faculty of Medicine

Imperial College of Medicine

Charing Cross Hospital

London

UK

Disclosures

AHD declares that he has no competing interests.

Peer reviewers VIEW ALL

Department of Vascular Surgery

Red Cross Hospital

Athens

Greece

Disclosures

KIP declares that he has no competing interests.

Assistant Professor of Surgery

Division of Vascular Surgery

University of Texas Health Science Center at San Antonio

San Antonio

TX

Disclosures

MKS declares that she has no competing interests.

Chief of Vascular Surgery

Director

Gonda Vascular Center

David Geffen School of Medicine at UCLA

Los Angeles

CA

Disclosures

PFL declares that he has no competing interests.

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