An Iranian scoring system for diagnosing Buerger's disease.

  • Mohammad Ramin Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Javad Salimi Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Alipasha Meysamie Department of Community and Preventive Medicine, Medical Faculty, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Burger Disease, Diagnostic Criteria, Limb Ischemia, Papa Score


Buerger's disease or thromboangiitis obliterans (TAO) seems to be common in IR Iran, The present study aimed to evaluate an Iranian population with Buerger's disease in order to suggest a diagnostic criterion for Buerger's disease based on the most frequent findings and to compare it with Papa diagnostic criteria. In a cross-sectional study, all patients with resting limb pain, limb ischemic ulcers, intermittent claudication and limb ischemia who referred to the Vascular Clinic of Sina Hospital during 2009-2011 were evaluated. The patients were allocated to Buerger's and non-Buerger's groups; Evaluating 122 patients (61 in each group), according to the model each clinical manifestations and risk factors in the patients with Buerger's disease obtained a score. Absent pulsation, abnormal distal Doppler sonography and ischemic ulcer were respectively present in 58 (95.1%), 58 (95.1%) and 49 (80.3%) individuals with Buerger's disease. Multivariate linear regression analysis and multivariate logistic regression analysis were used for modeling. Considering the model finding findings, diagnostic criteria including age, sex, smoking, Raynaud's phenomenon, abnormal proximal Doppler, diabetes mellitus and hyperlipidemia were suggested (R2=0.582); the sensitivity and specificity of the criteria was respectively 95.1% and 78.7%. Compared with Papa criteria, Kappa coefficient was measured at 0.66 with a P-value<0.001. It seems that the recommended criteria have an acceptable accuracy in diagnosing Buerger's disease, especially in the Iranian population; however, it is necessary to conduct more studies with larger sample sizes to evaluate the criteria, especially in other populations.


Lie JT. The rise and fall and resurgence of thromboangiitis obliterans (Buerger's disease). Acta pathol Jpn 1989;39(3):153-8.

Laohapensang K, Rerkasem K, Kattipattanapong K. Decrease in the incidence of Buerger's disease recurrence in northern Thailand. Surg Today 2005;35(12):1060-5.

Kinare SG, kher YR, Rao G, et al. Pattern of occlusive peripheral vascular disease in India. (clinicopathological study of 79 cases). Angiology 1976;27(3):165-80.

Lazarides MK, Georgiadis GS, Papas IT, et al. Diagnostic criteria and treatment of Buerger's disease: a review. Int J low Extrem Wounds 2006;5(2):89-95.

Puechal X, Fiessinger JN. Thromboangiitis obliterans or Buerger's disease: challenges for the rheumatologist. Rheumatology 2007;46(2):192-9.

Papa MZ, Rabi I, Adar R. A point scoring system for the clinical diagnosis of Buerger's disease. Eur J Vasc Endovasc Surg 1996;11(3):335-9.

Shionoya S. Diagnostic criteria of Buerger's disease. Int J Cardiol 1998;66(Suppl 1): S243-5.

Olin JW. Thromboangiitis obliterans (Buerger's disease). N Engl J Med 2000;343(12):864-9.

Kobayashi M, Nishikimi N, Komori K. Current pathological and clinical aspects of Buerger's disease in Japan. Ann Vasc Surg 2006;20(1):148-56.

Tavakoli H, rezaii J, Esfandiari K, et al. Buerger's disease: a 10-year experience in Tehran, Iran. Clin Rheumatol 2008;27(3):369-71.

Ates A, Yekeler I, Ceviz M, et al. One of the most frequent vascular diseases in northeastern of Turkey: Thromboangiitis obliterans or Buerger's disease(experience with 344 cases). Int J Cardiol 2006;111:147-53.

Olin JW, Young JR, Graor RA, et al. The changing clinical spectrum of thromboangiitis obliterans (Buerger's disease). Circulation 1990;82(5 Suppl):IV3-8.

Lie JT. Thromboangiitis obliterans (Buerger's disease) in women. Medicine 1987;66(1):65-72.

Adar R, Papa MZ, Halpem M, et al. Cellular sensitivity to collagen in thromboangiitis obliterans. N Engl J Med 1983;308(19):1113-6.

Mozes M, Cahansky G, Doitsch V, et al. The association of atherosclerosis and Buerger's disease: a clinical and radiological study. J Cardiovasc Surg 1970;11(1):52-9.

Fiessinger JN. Thromboangiitis obliterans (Buerger'sdisease). Rev Rhum Engl Ed 1997;64(5): 281-2.

McPherson JR, Juergens JL, Gifford RW Jr. Thromboangiitis Obliterans and Arteriosclerosis Obliterans. Clinical and Prognostic Differences. JAMA 1963;186(2):189.

Fiessinger JN, Schafer M. Trial of iloprost versus aspirin treatment for critical limb ischaemia of thromboangiitis obliterans. The TAO Study. Lancet 1990;335(8689):555-7.

Mills JL, Porter JM. Buerger's disease: a review and update. Semin Vasc Surg 1993;6(1):14-23.

How to Cite
Ramin M, Salimi J, Meysamie A. An Iranian scoring system for diagnosing Buerger’s disease. Acta Med Iran. 52(1):60-65.