Buerger's disease future or investigational therapies: Difference between revisions
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==Future or Investigational Therapies== | ==Future or Investigational Therapies== | ||
===Therapeutic angiogenesis=== | |||
*Patients with ischemic pain or non-healing ulcers may benefit from therapeutic [[angiogenesis]] that uses grow factors, such as intramuscular [[vascular endothelial growth factor]], or through the introduction of a Kirschner wire placed in the medullary canal of the tibia (distraction osteogenesis) in order to promote the generation of blood vessels.<ref name="pmid9845647">{{cite journal |vauthors=Isner JM, Baumgartner I, Rauh G, Schainfeld R, Blair R, Manor O, Razvi S, Symes JF |title=Treatment of thromboangiitis obliterans (Buerger's disease) by intramuscular gene transfer of vascular endothelial growth factor: preliminary clinical results |journal=J. Vasc. Surg. |volume=28 |issue=6 |pages=964–73; discussion 73–5 |date=December 1998 |pmid=9845647 |doi= |url=}}</ref> <ref name="pmid17652224">{{cite journal |vauthors=Saito S, Nishikawa K, Obata H, Goto F |title=Autologous bone marrow transplantation and hyperbaric oxygen therapy for patients with thromboangiitis obliterans |journal=Angiology |volume=58 |issue=4 |pages=429–34 |date=2007 |pmid=17652224 |doi=10.1177/0003319706292015 |url=}}</ref><ref name="pmid15694801">{{cite journal |vauthors=Inan M, Alat I, Kutlu R, Harma A, Germen B |title=Successful treatment of Buerger's Disease with intramedullary K-wire: the results of the first 11 extremities |journal=Eur J Vasc Endovasc Surg |volume=29 |issue=3 |pages=277–80 |date=March 2005 |pmid=15694801 |doi=10.1016/j.ejvs.2004.12.011 |url=}}</ref><ref name="pmid21886930">{{cite journal |vauthors=Kulkarni S, Kulkarni G, Shyam AK, Kulkarni M, Kulkarni R, Kulkarni V |title=Management of thromboangiitis obliterans using distraction osteogenesis: A retrospective study |journal=Indian J Orthop |volume=45 |issue=5 |pages=459–64 |date=September 2011 |pmid=21886930 |pmc=3162685 |doi=10.4103/0019-5413.83954 |url=}}</ref> | |||
*Therapeutic [[angiogenesis]] has also demonstrated that it may reduce the occurrence of nocturnal resting pain. | |||
===Autologous bone marrow mononuclear cell implantation=== | |||
*When traditional [[revascularization]] interventions have failed in those with severe [[Peripheral arterial disease|peripheral artery disease]], autologous bone marrow mononuclear cell implantation may be performed.<ref name="pmid9845647">{{cite journal |vauthors=Isner JM, Baumgartner I, Rauh G, Schainfeld R, Blair R, Manor O, Razvi S, Symes JF |title=Treatment of thromboangiitis obliterans (Buerger's disease) by intramuscular gene transfer of vascular endothelial growth factor: preliminary clinical results |journal=J. Vasc. Surg. |volume=28 |issue=6 |pages=964–73; discussion 73–5 |date=December 1998 |pmid=9845647 |doi= |url=}}</ref> | |||
*Autologous bone marrow mononuclear cell implantation may be able to relieve ischemic pain symptoms and decrease ulcer size, whilst increasing walking distance. | |||
===Immunoabsorption therapy, bosentan and cilostazol=== | |||
*Immunoabsorption therapy and [[bosentan]] ([[endothelin receptor antagonist]]) have demonstrated that they are effective in improving pain intensity and ulcer healing.<ref name="pmid15365252">{{cite journal |vauthors=Kim HJ, Jang SY, Park JI, Byun J, Kim DI, Do YS, Kim JM, Kim S, Kim BM, Kim WB, Kim DK |title=Vascular endothelial growth factor-induced angiogenic gene therapy in patients with peripheral artery disease |journal=Exp. Mol. Med. |volume=36 |issue=4 |pages=336–44 |date=August 2004 |pmid=15365252 |doi=10.1038/emm.2004.44 |url=}}</ref> <ref name="pmid22333218">{{cite journal |vauthors=De Haro J, Acin F, Bleda S, Varela C, Esparza L |title=Treatment of thromboangiitis obliterans (Buerger's disease) with bosentan |journal=BMC Cardiovasc Disord |volume=12 |issue= |pages=5 |date=February 2012 |pmid=22333218 |pmc=3306190 |doi=10.1186/1471-2261-12-5 |url=}}</ref> | |||
*[[Cilostazol]] ([[Phosphodiesterase inhibitors|phosphodiesterase inhibitor]]) is a suppressor of [[platelet aggregation]] and a direct arterial vasodilator, it is able to casue a reactive hyperemia and therefore, improve blood flow.<ref name="pmid4074434">{{cite journal |vauthors=Yasuda K, Sakuma M, Tanabe T |title=Hemodynamic effect of cilostazol on increasing peripheral blood flow in arteriosclerosis obliterans |journal=Arzneimittelforschung |volume=35 |issue=7A |pages=1198–200 |date=1985 |pmid=4074434 |doi= |url=}}</ref> | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Future or Investigational Therapies
Therapeutic angiogenesis
- Patients with ischemic pain or non-healing ulcers may benefit from therapeutic angiogenesis that uses grow factors, such as intramuscular vascular endothelial growth factor, or through the introduction of a Kirschner wire placed in the medullary canal of the tibia (distraction osteogenesis) in order to promote the generation of blood vessels.[1] [2][3][4]
- Therapeutic angiogenesis has also demonstrated that it may reduce the occurrence of nocturnal resting pain.
Autologous bone marrow mononuclear cell implantation
- When traditional revascularization interventions have failed in those with severe peripheral artery disease, autologous bone marrow mononuclear cell implantation may be performed.[1]
- Autologous bone marrow mononuclear cell implantation may be able to relieve ischemic pain symptoms and decrease ulcer size, whilst increasing walking distance.
Immunoabsorption therapy, bosentan and cilostazol
- Immunoabsorption therapy and bosentan (endothelin receptor antagonist) have demonstrated that they are effective in improving pain intensity and ulcer healing.[5] [6]
- Cilostazol (phosphodiesterase inhibitor) is a suppressor of platelet aggregation and a direct arterial vasodilator, it is able to casue a reactive hyperemia and therefore, improve blood flow.[7]
References
- ↑ 1.0 1.1 Isner JM, Baumgartner I, Rauh G, Schainfeld R, Blair R, Manor O, Razvi S, Symes JF (December 1998). "Treatment of thromboangiitis obliterans (Buerger's disease) by intramuscular gene transfer of vascular endothelial growth factor: preliminary clinical results". J. Vasc. Surg. 28 (6): 964–73, discussion 73–5. PMID 9845647.
- ↑ Saito S, Nishikawa K, Obata H, Goto F (2007). "Autologous bone marrow transplantation and hyperbaric oxygen therapy for patients with thromboangiitis obliterans". Angiology. 58 (4): 429–34. doi:10.1177/0003319706292015. PMID 17652224.
- ↑ Inan M, Alat I, Kutlu R, Harma A, Germen B (March 2005). "Successful treatment of Buerger's Disease with intramedullary K-wire: the results of the first 11 extremities". Eur J Vasc Endovasc Surg. 29 (3): 277–80. doi:10.1016/j.ejvs.2004.12.011. PMID 15694801.
- ↑ Kulkarni S, Kulkarni G, Shyam AK, Kulkarni M, Kulkarni R, Kulkarni V (September 2011). "Management of thromboangiitis obliterans using distraction osteogenesis: A retrospective study". Indian J Orthop. 45 (5): 459–64. doi:10.4103/0019-5413.83954. PMC 3162685. PMID 21886930.
- ↑ Kim HJ, Jang SY, Park JI, Byun J, Kim DI, Do YS, Kim JM, Kim S, Kim BM, Kim WB, Kim DK (August 2004). "Vascular endothelial growth factor-induced angiogenic gene therapy in patients with peripheral artery disease". Exp. Mol. Med. 36 (4): 336–44. doi:10.1038/emm.2004.44. PMID 15365252.
- ↑ De Haro J, Acin F, Bleda S, Varela C, Esparza L (February 2012). "Treatment of thromboangiitis obliterans (Buerger's disease) with bosentan". BMC Cardiovasc Disord. 12: 5. doi:10.1186/1471-2261-12-5. PMC 3306190. PMID 22333218.
- ↑ Yasuda K, Sakuma M, Tanabe T (1985). "Hemodynamic effect of cilostazol on increasing peripheral blood flow in arteriosclerosis obliterans". Arzneimittelforschung. 35 (7A): 1198–200. PMID 4074434.