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    An International Delphi Consensus on Diagnostic Criteria for Buerger's Disease
    (Elsevier Inc., 2022) Fazeli, Bahare; Poredoš, Pavel; Schernthaner, Gerit Holger; Stephen, Edwin; Kozak, Matija; Catalano, Mariella; Pécsvárady, Zsolt
    Background: Buerger's disease (BD) remains a debilitating condition. Despite multiple published diagnostic criteria for BD, none is universally accepted as a gold standard. Methods: We conducted a 2-round modified Delphi consensus study to establish a consensus on the diagnostic. The questionnaire included statements from several commonly used diagnostic criteria for BD. Qualitative and quantitative analysis methods were performed. An agreement level of 70% was applied. Results: Twenty nine experts from 18 countries participated in this study. Overall, 75 statements were circulated in Round 1. Of these, 28% of statements were accepted. Following comments, 21 statements were recirculated in Round 2 and 90% were accepted. Although more than 90% of the experts did not agree that the diagnosis of BD can be based only on clinical manifestation, none of the nonclinical manifestations of BD were agreed as a part of the diagnostic criteria. There was an agreement that a history of tobacco consumption in any form, not necessarily confined to the current use, should be a part of the diagnostic criteria of BD. The history of thrombophlebitis migrans, even if not present at presentation, was accepted as a clue for BD diagnosis. It was also agreed that discoloration of the toes or fingers could be included in the diagnostic criteria of BD. Experts agreed that histology results could differentiate BD from atherosclerosis obliterans and other types of vasculitis. The presence of corkscrew collaterals on imaging and burning pain reached the agreement at the first round but not at the second. There was no consensus regarding age cut-off, the requirement of normal lipid profile, and normal blood glucose for BD diagnosis. Conclusions: The present study demonstrated discrepancies in the various published diagnostic criteria for BD and their selective utilization in routine clinical practice worldwide. We propose that all published diagnostic criteria for BD be re-evaluated for harmonization and universal use. © 2022
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    Milestones in thromboangiitis obliterans: a position paper of the VAS-European independent foundation in angiology/vascular medicine
    (Edizioni Minerva Medica, 2021) Fazeli, Bahare; Poredos, Pavel; Patel, Malay; Klein-Weigel, Peter; Catalano, Mariella; Stephen, Edwin; Al Salman, Mussaad M.
    1School of Medicine, Division of Inflammation and Inflammatory Diseases, Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 2Slovenia Academic Research Center, Slovenian Medical Academy, Medical Association of Slovenia and SMA, Ljubljana, Slovenia; 3Department of Vascular Surgery, Apollo-CVHF Hospital, Ahmedabad, India; 4Clinic of Angiology, Zentrum f iota ir Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany; 5Unit of Angiology, Department of Biomedical Science, Research Center on Vascular Disease, L. Sacco Hospital, University of Milan, Milan, Italy; 6Department of Vascular Surgery, Sultan Qaboos University Hospital, Muscat, Oman; 7Division of Vascular Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia; 8Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria; 9National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh; 10Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; 11Department of Vascular Surgery, St. James's Hospital/Trinity College Dublin, Dublin, Ireland; 12Department of Vascular Surgery, University Hospital Mekur, Zagreb, Croatia; 13Department of Vascular and Endovascular Surgery, Ramaiah Medical College Hospital, Bangalore, India; 14Unit of Vascular Surgery, Third Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece; 15Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey; 16Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary; 17Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, UK; 18Hematology and Thrombosis Center, Hopitaux Universitaires de l'Est Parisien, Assistance Publique Hopitaux de Paris, Faculty of Medicine,
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    The Angiography Pattern of Buerger's Disease: Challenges and Recommendations
    (Mdpi, 2025) Fazeli, Bahare; Poredos, Pavel; Liew, Aaron; Stephen, Edwin; Bashar, Abul Hasan Muhammad; Kozak, Matija; Catalano, Mariella
    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.