Criteria

Shionoya clinical criteria of diagnosis[29]

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 2006 to make the diagnosis of Buerger disease.[29] However, patients >50 years of age have been given the diagnosis. Probable Buerger disease is considered when all but the fourth criterion are met.

Point scoring system of diagnosis (Papa criteria)[30]

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 color 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, hypercholesterolemia: 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

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