Thromboangiitis Obliterans (Buerger’s Disease)

Abstract

Thromboangiitis obliterans (TAO) is a devastating nonatherosclerotic disease that often leads to digit and limb loss as well as intractable ischemic rest pain. Patients with TAO are uniformly heavy users of tobacco. This disorder is characterized as a miscellaneous form of vasculitis affecting small- and medium-sized arteries and veins. TAO causes painful ischemic ulcers of the digits and unusually painful and inflammatory superficial thrombophlebitis. The key to early diagnosis of TAO is a high clinical index of suspicion in the appropriate patient scenario, exclusion of any other potential cause, abnormal results from an Allen's test, and arteriographic findings of segmental digital arterial occlusions with "corkscrew" collateral vessels. The primary and clearly most effective therapy for TAO is cessation of the use of all tobacco products, with avoidance of any environmental tobacco smoke inhalation. There has been recent enthusiasm for prostaglandin E therapy and the intramuscular injection of angiogenic growth factors. For patients in whom the disease is identified late or for those who are unable to discontinue cigarette smoking, however, a frequent result is multiple limb amputations.

Therapeutic Neovascularization by the Implantation of Autologous Mononuclear Cells in Patients with Connective Tissue Diseases

“…Although the etiology of TAO remains unknown, this condition is considered to represent nonspecific vasculitis associated with unknown autoimmune mechanisms [8,47]. Therefore, we are currently conducting a prospective, non-randomized, and multicenter clinical pilot study to determine the efficacy of autologous mononuclear cell implantation into the critically ischemic digits of patients with CTDs [48].…”

Chronic Ulcers in Thromboangiitis Obliterans (Buerger's Disease): Updating Epidemiology, Physiopathology, and Bosentan—A Novel Strategy of Therapy

“…Only a few pharmacological and surgical options (of controversial efficacy) are available to date to improve healing ulcers in TAO [8]. Vasodilators, antiplatelet agents, anticoagulants, and corticosteroids appear to be of no use [37]. Prostaglandin analogues are beneficial when administered intravenously [38], although their efficacy is controversial on oral administration [39].…”

“…Meanwhile, sympathectomy may alleviate the pain and improves superficial ulcers, but it does not prevent or reduce the number of amputations [37]. Surgical revascularization is not usually feasible because of the diffuse and segmental character of the disease [37]. Thus, new therapeutic options with a higher efficacy than the current ones are clearly needed in order to properly manage patients affected by TAO.…”

Initial Evidence in Thromboangiitis Obliterans (Buerger’s Disease) Treatment with Bosentan

“…25 Only a few pharmacological and surgical options (of controversial efficacy) are available to encourage healing of ulcers in TAO. 26 Vasodilators, antiplatelet agents, anticoagulants, and corticosteroids appear to be of no use. 26 Prostaglandin analogues are beneficial when administered intravenously, although their efficacy is controversial on oral administration.…”

“…26 Vasodilators, antiplatelet agents, anticoagulants, and corticosteroids appear to be of no use. 26 Prostaglandin analogues are beneficial when administered intravenously, although their efficacy is controversial on oral administration. A randomised clinical trial of intravenous iloprost versus aspirin 27 has shown that the healing of ulcers is higher in patients who have received treatment with intravenous prostaglandins.…”