Coexistência de tromboangeíte obliterante e doença arterial coronariana aterosclerótica: uma associação incomum com implicações diagnósticas.

• Autores: Orozco Martínez, Manuela, Orozco, Santiago, Sánchez Cano, Fabio M., Rivera Castrillón, Santiago, Sánchez Gutierrez, Andrea
• Formato: artículo
• Fecha de Publicación: 2026
• Institución: Universidad de San Martín de Porres
• Repositorio: Horizonte médico
• Lenguaje: español
• OAI Identifier: oai:horizontemedico.usmp.edu.pe:article/4328
• Enlace del recurso: https://horizontemedico.usmp.edu.pe/index.php/horizontemed/article/view/4328
• Nivel de acceso: acceso abierto
• Materia: Thromboangiitis Obliterans; Vasculitis; Chronic Limb-Threatening Ischemia; Coronary Disease; Tromboangítis Obliterante; Isquemia Crónica que Amenaza las Extremidades; Enfermedad Coronaria; Doença de Buerger; Vasculite não aterosclerótica; Isquemia crítica; Doença arterial coronariana.

Thromboangiitis obliterans is a non-atherosclerotic vasculitis associated with tobacco use, characterized by predominant involvement of peripheral vessels and a progressive course. Coronary involvement is uncommon, and its coexistence with atherosclerotic coronary artery disease poses a diagnostic and therapeutic challenge.We report the case of a 43-year-old man, a chronic smoker with a prior diagnosis of advanced thromboangiitis obliterans and a history of multiple distal amputations, who presented with ischemic chest pain. Evaluation revealed a non–ST-segment elevation acute coronary syndrome with elevated biomarkers of myocardial necrosis. Coronary angiography demonstrated chronic total occlusion of the left anterior descending artery, with no options for percutaneous or surgical revascularization. Therefore, optimal medical management was initiated, including antiplatelet therapy, a high-intensity statin, and strict control of cardiovascular risk factors, together with an intensive strategy for complete smoking cessation. The clinical course was stable, with no recurrence of angina during hospitalization, and the patient was discharged with outpatient follow-up by cardiology and vascular surgery.This case illustrates that, although thromboangiitis obliterans is considered a non-atherosclerotic vasculitis, patients may develop significant coronary artery disease and even present with acute coronary syndrome, particularly in the context of persistent tobacco exposure. Therefore, cardiovascular risk assessment in patients with advanced thromboangiitis obliterans and signs or symptoms of myocardial ischemia should be considered as part of the differential diagnosis. Complete smoking cessation remains the cornerstone of management and the most important disease-modifying intervention.