According  to final vote of VAS members, this is the protocol of including Buerger’s cases into VAS image and VAS international biobank on Buerger’s disease:
Buerger’s disease diagnosis should be based on both clinical and angiography findings.

The clinical signs and symptoms which should be considered for Buerger’s disease diagnosis are:

  1. The age of disease onset less than 50 years

  2. Experience of circadian rhythmic burning pain

  3. History of smoking

  4. Involvement of Small- and medium-sized arteries of the lower limb; including foot or calf claudication, popliteal, posterior tibial or dorsalis pedis pulse impairment with intact femoral pulses

  5. Thrombophlebitis migrans or involvement of upper limbs including impaired Allen’s test

  6. Asymmetric Buerger’s purple color on edematous toes

  7. Normal fast blood sugar and lipid profile and normal blood pressure

Buerger’s disease diagnosis for patients who complete the clinical criteria, should be confirmed by angiography or other imagings.

The imaging findings which should be considered for TAO diagnosis are:

  1. Abrupt blockage of small and medium arteries

  2. Smooth and non-atherosclerotic artery wall both at the site of, and also proximally to arterial occlusions.

  3. Corkscrew collaterals

  4. Skip lesions and segmental occlusions (optional)

  5. Now, what to do with the patients who have mild dyslipidemia or if they do not have the history of thrombophelebitlits migrans, upper limb ischemia, circadian rhythmic burning pain or Buerger’s color?

  6. It is suggested to make another category so-called “uncertain Buerger’s disease” and bank their images and biological samples separately. Maybe in future we can find whether they had suffered from Buerger’s disease or any other kind of PAD.

2.Informed broad consent form:

3. Samples collections/Methods:

  1. Totally, 5 to 10 cc blood sample from every volunteer patient collected in EDTA sterile tube.

  2. All the joined centers should have freezer -70 for banking plasma samples, blood samples and , tissue samples in RNAlater.

  3. The samples should be aliquot in 0.5 microtubes for avoiding de-freezing.

  4. The joined centers which doesn’t have freezer -70, can just bank blood samples for  further DNA extraction, in -20 freezer.

4. Tissue bank

  1. It is preferred to insert the tissue in cool formalin (about 4°C).

  2. If the joined center has freezer -70, it is preffered to insert the tissue (maximum 4*4mm) in RNAlater solution, keeping in 4°C over night and then banking in the freezer.

  3. It is preferred to bank paraffin blocks of tissue samples in room temperature in parallel with other biologic samples.

  4. If the joined center has some paraffin blocks of tissue samples of some rare diseases such as Buerger’s disease, the tissue samples could also include in VAS tissue bank if:

  5. Based on hospital documents of the patients, the diagnosis criteria for Buerger’s disease should be as the same as “VAS buerger’s diagnosis criteria”.

  6. The ethical committee of the joined center gives the consent of studying on the tissue samples.

5. Image bank

  1. The diagnosis should be based on unique diagnostic criteria approved by VAS.

  2. The informed consent form should be obtained from the patient.

  3. No questionnaire is needed. Only an educational note for each image is enough.

  4. If any center or researcher submits more than 20 educational images approved by VAS, then the center or researcher can have access to other submitted images and can use them in presentations by referencing