An International Delphi Consensus on Diagnostic Criteria for Buerger's Disease

Background: Buerger's disease (BD) remains a debilitating condition. Despite multiple pub-lished 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 diag-nostic criteria for BD. Qualitative and quantitative analysis methods were performed. An agree-ment level of 70% was applied.Results: Twenty nine experts from 18 countries participated in this study. Overall, 75 state-ments were circulated in Round 1. Of these, 28% of statements were accepted. Following com-ments, 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 diag-nostic 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 col -laterals on imaging and burning pain reached the agreement at the first round but not at the sec-ond. 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 diag-nostic criteria for BD and their selective utilization in routine clinical practice worldwide. We pro-pose that all published diagnostic criteria for BD be re-evaluated for harmonization and universal use.