Buerger's disease medical therapy: Difference between revisions

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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
There is no treatment for Buerger's disease. In order to prevent progression and control symptoms, [[smoking cessation]] is crucial. [[Smoking cessation]] does not reverse damage already caused. Pharmacologic medical therapies for Buerger's disease include [[smoking cessation]], [[palliative treatment]]<nowiki/>s, [[prostaglandin analogs]] and [[phosphodiesterase inhibitors]], [[Calcium channel blocker|calcium channel blockers]], [[Endothelin receptor antagonist|endothelin receptor antagonists]], [[compression therapy]] and some experimental therapies. It should be noted, however, that these therapies are purely palliative and do not reverse previous damage caused. [[Analgesic|Analgesics]] including [[Non-steroidal anti-inflammatory drug|NSAIDs]] and [[acetaminophen]] may be used to provide pain relief.  


OR
==Medical Therapy==
 
Pharmacologic medical therapies for Buerger's disease include [[smoking cessation]], [[Palliative treatment|palliative treatments]], [[prostaglandin analogs]] and [[phosphodiesterase inhibitors]], [[Calcium channel blocker|calcium channel blockers]], [[Endothelin receptor antagonist|endothelin receptor antagonists]], [[compression therapy]] and some experimental therapies. It should be noted, however, that these therapies are purely palliative and do not reverse previous damage caused.<ref name="pmid10995867">{{cite journal |vauthors=Olin JW |title=Thromboangiitis obliterans (Buerger's disease) |journal=N. Engl. J. Med. |volume=343 |issue=12 |pages=864–9 |date=September 2000 |pmid=10995867 |doi=10.1056/NEJM200009213431207 |url=}}</ref><ref name="pmid2225420">{{cite journal |vauthors=Olin JW, Young JR, Graor RA, Ruschhaupt WF, Bartholomew JR |title=The changing clinical spectrum of thromboangiitis obliterans (Buerger's disease) |journal=Circulation |volume=82 |issue=5 Suppl |pages=IV3–8 |date=November 1990 |pmid=2225420 |doi= |url=}}</ref><ref name="pmid14718836">{{cite journal |vauthors=Ohta T, Ishioashi H, Hosaka M, Sugimoto I |title=Clinical and social consequences of Buerger disease |journal=J. Vasc. Surg. |volume=39 |issue=1 |pages=176–80 |date=January 2004 |pmid=14718836 |doi=10.1016/j.jvs.2003.08.006 |url=}}</ref>
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.


OR
===Smoking cessation===
*[[Smoking cessation]] is crucial to the management of Buerger's disease. Not only does [[smoking cessation]] halt progression but also controls [[pain]] symptoms and decreases the risk of [[amputation]].<ref name="pmid10995867">{{cite journal |vauthors=Olin JW |title=Thromboangiitis obliterans (Buerger's disease) |journal=N. Engl. J. Med. |volume=343 |issue=12 |pages=864–9 |date=September 2000 |pmid=10995867 |doi=10.1056/NEJM200009213431207 |url=}}</ref><ref name="pmid2225420">{{cite journal |vauthors=Olin JW, Young JR, Graor RA, Ruschhaupt WF, Bartholomew JR |title=The changing clinical spectrum of thromboangiitis obliterans (Buerger's disease) |journal=Circulation |volume=82 |issue=5 Suppl |pages=IV3–8 |date=November 1990 |pmid=2225420 |doi= |url=}}</ref><ref name="pmid14718836">{{cite journal |vauthors=Ohta T, Ishioashi H, Hosaka M, Sugimoto I |title=Clinical and social consequences of Buerger disease |journal=J. Vasc. Surg. |volume=39 |issue=1 |pages=176–80 |date=January 2004 |pmid=14718836 |doi=10.1016/j.jvs.2003.08.006 |url=}}</ref>
*The patient may, however, still suffers from intermittent [[claudication]] or [[Raynaud's phenomenon|Raynaud phenomenon]].
*Complete abstinence from [[smoking]] is a must as Buerger's disease in susceptible individuals can be triggered by a single cigarette.
*Any anti-smoking aid containing [[nicotine]] such as transdermal patches or gum must be avoided as they may also trigger the disease.
*Anti-smoking aids such as [[bupropion]] or [[varenicline]] may be of use and do not contribute to disease progression.
*A patient that claims to have stopped smoking but continues to suffer symptoms of active disease should be tested for urinary [[nicotine]] and [[cotinine]].
*Previous studies have demonstrated that only 50% of patients with Buerger's disease are able to quit smoking. In these patients, nicotine dependence treatment may be sought.


The mainstay of treatment for [disease name] is [therapy].
===Iloprost===
*[[Iloprost]] is a [[Prostaglandin analogs|prostaglandin analog]] and is available in an [[IV|intravenous]] and oral forms.<ref name="pmid9610341">{{cite journal |vauthors= |title=Oral iloprost in the treatment of thromboangiitis obliterans (Buerger's disease): a double-blind, randomised, placebo-controlled trial. The European TAO Study Group |journal=Eur J Vasc Endovasc Surg |volume=15 |issue=4 |pages=300–7 |date=April 1998 |pmid=9610341 |doi= |url=}}</ref><ref name="pmid1689791">{{cite journal |vauthors=Fiessinger JN, Schäfer M |title=Trial of iloprost versus aspirin treatment for critical limb ischaemia of thromboangiitis obliterans. The TAO Study |journal=Lancet |volume=335 |issue=8689 |pages=555–7 |date=March 1990 |pmid=1689791 |doi= |url=}}</ref><ref name="pmid16763533">{{cite journal |vauthors=Bozkurt AK, Köksal C, Demirbas MY, Erdoğan A, Rahman A, Demirkiliç U, Ustünsoy H, Metin G, Yillik L, Onol H, Cinar B, Karaçelik M, Erdinç I, Bolcal C, Sayin AG |title=A randomized trial of intravenous iloprost (a stable prostacyclin analogue) versus lumbar sympathectomy in the management of Buerger's disease |journal=Int Angiol |volume=25 |issue=2 |pages=162–8 |date=June 2006 |pmid=16763533 |doi= |url=}}</ref>
*[[Iloprost]] is expensive and not available in the USA.
*[[Iloprost]] is especially effective in the intravenous form at reducing pain symptoms, better than low dose [[aspirin]] or lumbar [[sympathectomy]].
*[[Iloprost]] can facilitate [[smoking cessation]] and may be used to manage resting pain symptoms in those patients with critical [[limb ischemia]].
*[[Iloprost]] may also hasten [[ulcer]] healing.


OR
===Calcium channel blockers===
 
*[[Calcium channel blocker|Calcium channel blockers]] are used in patients whose main complaint is [[Raynaud's phenomenon|Raynaud phenomenon]].<ref name="pmid10995867">{{cite journal |vauthors=Olin JW |title=Thromboangiitis obliterans (Buerger's disease) |journal=N. Engl. J. Med. |volume=343 |issue=12 |pages=864–9 |date=September 2000 |pmid=10995867 |doi=10.1056/NEJM200009213431207 |url=}}</ref>
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
*[[Calcium channel blocker|Calcium channel blockers]] that prevent [[vasospasm]] include the [[Dihydropyridine|dihydropyridines]] such as, [[nifedipine]], [[nicardipine]] and, [[amlodipine]].
===Intermittent pneumatic compression===
*[[Intermittent pneumatic compression]] (IPC) is used in patients whose main complaint is that of poor circulation and healing in the extremities.<ref name="pmid9790203">{{cite journal |vauthors=Labropoulos N, Watson WC, Mansour MA, Kang SS, Littooy FN, Baker WH |title=Acute effects of intermittent pneumatic compression on popliteal artery blood flow |journal=Arch Surg |volume=133 |issue=10 |pages=1072–5 |date=October 1998 |pmid=9790203 |doi= |url=}}</ref>
*IPC is a therapy that is able to increase the flow of blood through the arteries by decreasing the peripheral arterial resistance.  


OR
===Experimental 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.


[Therapy] is recommended among all patients who develop [disease name].
====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.


OR
====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>


Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
===Analgesia===
 
*[[Non-steroidal anti-inflammatory drug|Non-steroidal anti-inflammatory drugs]] may be used to relieve pain symptoms, including [[naproxen]],[[ibuprofen]], [[indomethacin]], [[diclofenac]], and ketofen.<ref name="pmid10995867">{{cite journal |vauthors=Olin JW |title=Thromboangiitis obliterans (Buerger's disease) |journal=N. Engl. J. Med. |volume=343 |issue=12 |pages=864–9 |date=September 2000 |pmid=10995867 |doi=10.1056/NEJM200009213431207 |url=}}</ref><ref name="pmid2225420">{{cite journal |vauthors=Olin JW, Young JR, Graor RA, Ruschhaupt WF, Bartholomew JR |title=The changing clinical spectrum of thromboangiitis obliterans (Buerger's disease) |journal=Circulation |volume=82 |issue=5 Suppl |pages=IV3–8 |date=November 1990 |pmid=2225420 |doi= |url=}}</ref>
OR
*[[Acetaminophen]]<nowiki/>used alone, or with [[codeine]] or [[hydrocodone]], is also effective.  
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===
 
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 
 
==Medical Therapy==
Symptoms are treated as there is no treatment for the disease. Cessation of tobacco use may slow any further progression of the disease.
The goal of treatment for Buerger's disease is to control symptoms.
*Quitting smoking
*Keep warm and do regular exercises may help increase circulation.
*[[Medication]]s: The following medications have shown somewhat effective in improving distal blood flow and relieve symptoms.  
:*[[Iloprost]], a prostaglandin analogue
:*Stem cell injection
:*[[Streptokinase]]


===Management of ulcers===
*Digital ulcers may be treated with [[debridement]] and moist dressing.<ref name="pmid17980686">{{cite journal |vauthors=Canter HI, Isci E, Erk Y |title=Vacuum-assisted wound closure for the management of a foot ulcer due to Buerger's disease |journal=J Plast Reconstr Aesthet Surg |volume=62 |issue=2 |pages=250–3 |date=February 2009 |pmid=17980686 |doi=10.1016/j.bjps.2007.09.031 |url=}}</ref>
*[[Negative pressure wound therapy]] may be of benefit in open wounds.


==References==
==References==

Latest revision as of 19:36, 1 May 2018

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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]

Overview

There is no treatment for Buerger's disease. In order to prevent progression and control symptoms, smoking cessation is crucial. Smoking cessation does not reverse damage already caused. Pharmacologic medical therapies for Buerger's disease include smoking cessation, palliative treatments, prostaglandin analogs and phosphodiesterase inhibitors, calcium channel blockers, endothelin receptor antagonists, compression therapy and some experimental therapies. It should be noted, however, that these therapies are purely palliative and do not reverse previous damage caused. Analgesics including NSAIDs and acetaminophen may be used to provide pain relief.

Medical Therapy

Pharmacologic medical therapies for Buerger's disease include smoking cessation, palliative treatments, prostaglandin analogs and phosphodiesterase inhibitors, calcium channel blockers, endothelin receptor antagonists, compression therapy and some experimental therapies. It should be noted, however, that these therapies are purely palliative and do not reverse previous damage caused.[1][2][3]

Smoking cessation

  • Smoking cessation is crucial to the management of Buerger's disease. Not only does smoking cessation halt progression but also controls pain symptoms and decreases the risk of amputation.[1][2][3]
  • The patient may, however, still suffers from intermittent claudication or Raynaud phenomenon.
  • Complete abstinence from smoking is a must as Buerger's disease in susceptible individuals can be triggered by a single cigarette.
  • Any anti-smoking aid containing nicotine such as transdermal patches or gum must be avoided as they may also trigger the disease.
  • Anti-smoking aids such as bupropion or varenicline may be of use and do not contribute to disease progression.
  • A patient that claims to have stopped smoking but continues to suffer symptoms of active disease should be tested for urinary nicotine and cotinine.
  • Previous studies have demonstrated that only 50% of patients with Buerger's disease are able to quit smoking. In these patients, nicotine dependence treatment may be sought.

Iloprost

Calcium channel blockers

Intermittent pneumatic compression

  • Intermittent pneumatic compression (IPC) is used in patients whose main complaint is that of poor circulation and healing in the extremities.[7]
  • IPC is a therapy that is able to increase the flow of blood through the arteries by decreasing the peripheral arterial resistance.

Experimental 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.[8] [9][10][11]
  • 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.[8]
  • 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

Analgesia

Management of ulcers

References

  1. ↑ 1.0 1.1 1.2 1.3 Olin JW (September 2000). "Thromboangiitis obliterans (Buerger's disease)". N. Engl. J. Med. 343 (12): 864–9. doi:10.1056/NEJM200009213431207. PMID 10995867.
  2. ↑ 2.0 2.1 2.2 Olin JW, Young JR, Graor RA, Ruschhaupt WF, Bartholomew JR (November 1990). "The changing clinical spectrum of thromboangiitis obliterans (Buerger's disease)". Circulation. 82 (5 Suppl): IV3–8. PMID 2225420.
  3. ↑ 3.0 3.1 Ohta T, Ishioashi H, Hosaka M, Sugimoto I (January 2004). "Clinical and social consequences of Buerger disease". J. Vasc. Surg. 39 (1): 176–80. doi:10.1016/j.jvs.2003.08.006. PMID 14718836.
  4. ↑ "Oral iloprost in the treatment of thromboangiitis obliterans (Buerger's disease): a double-blind, randomised, placebo-controlled trial. The European TAO Study Group". Eur J Vasc Endovasc Surg. 15 (4): 300–7. April 1998. PMID 9610341.
  5. ↑ Fiessinger JN, Schäfer M (March 1990). "Trial of iloprost versus aspirin treatment for critical limb ischaemia of thromboangiitis obliterans. The TAO Study". Lancet. 335 (8689): 555–7. PMID 1689791.
  6. ↑ Bozkurt AK, Köksal C, Demirbas MY, Erdoğan A, Rahman A, Demirkiliç U, Ustünsoy H, Metin G, Yillik L, Onol H, Cinar B, Karaçelik M, Erdinç I, Bolcal C, Sayin AG (June 2006). "A randomized trial of intravenous iloprost (a stable prostacyclin analogue) versus lumbar sympathectomy in the management of Buerger's disease". Int Angiol. 25 (2): 162–8. PMID 16763533.
  7. ↑ Labropoulos N, Watson WC, Mansour MA, Kang SS, Littooy FN, Baker WH (October 1998). "Acute effects of intermittent pneumatic compression on popliteal artery blood flow". Arch Surg. 133 (10): 1072–5. PMID 9790203.
  8. ↑ 8.0 8.1 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ Canter HI, Isci E, Erk Y (February 2009). "Vacuum-assisted wound closure for the management of a foot ulcer due to Buerger's disease". J Plast Reconstr Aesthet Surg. 62 (2): 250–3. doi:10.1016/j.bjps.2007.09.031. PMID 17980686.

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