A 32-year-old man who smokes 20 cigarettes daily presents with rest pain and ulceration of the right index and middle fingers. He has a history of superficial thrombophlebitis. Ankle-brachial index is 0.6. Angiography shows segmental occlusions of the digital and tibial arteries with corkscrew collaterals. What is the most likely diagnosis?

• A Atherosclerotic peripheral arterial disease
• B Embolic occlusion from a cardiac source
• C Raynaud's phenomenon with digital ulceration
• D Thromboangiitis obliterans (Buerger's disease) ✓

Explanation

Thromboangiitis obliterans affects young heavy smokers under 45, involves medium and small vessels of both upper and lower limbs, and shows corkscrew collaterals on angiography. Upper limb involvement and migratory superficial thrombophlebitis distinguish it from atherosclerosis. Atherosclerotic PAD in a 32-year-old without diabetes or familial hyperlipidaemia is unlikely.

Reference: Rutherford's Vascular Surgery and Endovascular Therapy, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.