Corkscrew Collaterals in Thromboangitis Obliterans (Buerger’s Disease)

A 47-year-old man with a 15-year history of Buerger’s disease presented with sharp rest pain and ischemic necrosis at the tips of the toes of his right foot. Early treatments, including treatment with antithrombotic and vasodilating agents and sympathetectomy, did not improve his symptoms or ulcer. Minor amputation of the toes of his right foot was performed. Digital subtraction angiography showed avascular areas at the tip of the index finger and multiple occlusions of the distal arteries, with collateralization (corkscrew collaterals) around the area of occlusions in the right lower leg. Continuous-wave Doppler ultrasound is useful to assess lower-extremity peripheral arterial disease anatomy, severity, and progression. Corkscrew collaterals (Figure, A [arrows B and C]) in the right leg were able to be visualized as color Doppler flows of a snake sign (Figure, A [arrow B] and B, and online-only Data Supplement Movie) and a dot sign (Figure, A [arrow C] and C) through the use of continuous-wave Doppler ultrasound.

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Figure. A, Digital subtraction angiography shows corkscrew collaterals around the area of occlusions in the right lower leg. Continuous-wave Doppler ultrasound shows corkscrew collaterals as color Doppler flows of a snake sign (A [arrow B] and B) and a dot sign (A [arrow C] and C).