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

## TL;DR

This paper discusses the diagnostic criteria for Buerger’s Disease and highlights challenges in identifying its unique angiography patterns.

## Contribution

The paper clarifies typical angiography features of Buerger’s Disease and recommends further studies for better differentiation from other vasculitides.

## Key findings

- Segmental occlusion and corkscrew collaterals are key angiography features of Buerger’s Disease.
- Differentiating BD from other vasculitides using angiography remains limited due to insufficient data.
- Long-term follow-up studies on BD patients are recommended to improve diagnostic accuracy.

## 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.