Thromboangiitis Obliterans G005

Current RMA Instruments

Changes from previous Instruments

ICD Coding:

• ICD-10-AM Codes: I73.1

Brief description

Thromboangiitis obliterans is a nonatherosclerotic, segmental, inflammatory occlusive vascular disease affecting small and medium-sized arteries and veins. The condition most commonly affects the distal upper and lower limbs and may result in vascular insufficiency, thrombotic occlusion, ischaemic pain, ulceration or tissue loss. Superficial thrombophlebitis may also occur. The condition occurs strongly in association with tobacco exposure.

Confirming the diagnosis

The diagnosis is made clinically, supported by vascular imaging and exclusion of alternative causes of occlusive vascular disease. Clinical assessment may include evaluation of distal limb ischaemia, rest pain or claudication, ulceration or tissue necrosis, vascular insufficiency, and superficial thrombophlebitis.

Diagnostic imaging may include angiography or other vascular imaging studies demonstrating characteristic distal vessel involvement. Biopsy may provide confirmatory histopathological findings in some cases but is not usually required.

Management and confirmation are usually undertaken by a vascular surgeon.

Additional diagnoses covered by SOP

• Buerger's disease

Conditions not covered by SOP 

• Atherosclerotic peripheral vascular disease *
• Other vasculitides * or #
• Embolic or thrombotic vascular disease due to alternative causes #

* another SOP applies
# non-SOP condition

Clinical onset

Clinical onset generally corresponds to the time when symptoms and signs attributable to distal occlusive vascular disease first become clinically evident as confirmed by a vascular surgeon. Clinical onset may coincide with the time of diagnosis, or it may be possible to backdate clinical onset based on preceding symptoms or findings. Clinical features may include distal limb pain, claudication, ischaemia, ulceration, tissue discolouration or superficial thrombophlebitis.

Clinical worsening

Clinical worsening may be indicated by progression of vascular insufficiency, worsening pain, ulceration, tissue necrosis, progressive functional impairment or requirement for amputation. Specialist advice should be sought when assessing for possible clinical worsening and progression beyond the normal clinical course. Adverse outcomes may occur where there is inability to obtain timely and appropriate clinical management. Smoking cessation may reduce symptom progression and the risk of major amputation.