Conservative treatment of patients with thromboangiitis obliterans or cannabis-associated arteritis presenting with critical lower limb ischaemia

Abstract

Summary: Background:Proper management of patients with thromboangiitis obliterans (TAO) or cannabis-associated arteritis (CAA), presenting with critical lower limb ischaemia (CLI) remains controversial, and data are limited. Patients and methods: Patients with TAO or CAA presenting with CLI between 2011 and 2016 were retrospectively evaluated. Patients requiring primary intervention were excluded. Conservative treatment included: (a) weight-adjusted bemiparin plus six hours/day intravenous iloprost for 28 days, (b) aspirin (100 mg/day) plus cilostazol (100 mg twice/day) after discharge, and (c) strict recommendations/monitoring for smoking cessation. Main outcomes included symptom recession, ankle-brachial index (ABI) improvement, and healing of lesions at the time of discharge as well as amputation, revascularization, and abstinence rate during follow-up. Results: Overall, 23 patients (TAO: 15; CAA: 8) were included within six years, none of the patients reported any other factor than smoking. All patients presented with rest pain and 12 patients with ulcer or necrotic lesions. Mean ABI measurement at presentation was 0.46 ± 0.2, after 28 days of treatment, all patients showed improvement regarding clinical picture and ABI measurement (0.54 ± 0.1; p < 0.05). During follow-up, only three patients underwent bypass surgery and two patients underwent major amputation, although the smoking abstinence rate was very low (13 %). Conclusions: Intravenous iloprost plus bemiparin for 28 days together with per os aspirin plus cilostazol seem to produce promising results in patients with TAO/CAA, treated for CLI, even with a low smoking abstinence rate. However, larger series are needed to further evaluate inter-group differences and potential prognostic factors.

Primary Causes of Hospitalizations and Procedures, Predictors of In-hospital Mortality, and Trends in Cardiovascular and Cerebrovascular Events Among Recreational Marijuana Users: A Five-year Nationwide Inpatient Assessment in the United States

“…The reports suggest that THC affects the platelet function leading to increased aggregation. THC activates platelets by endocannabinoids: 2-arachidonoylglycerol (2-AG) and anandamide and enhances glycoprotein IIb-IIIa and P-selectin expression causing increased platelet aggregation [ 27 ]. These pathophysiological effects of marijuana have the potential of causing cerebral hemorrhages and other bleeding disorders.…”

Predictive value of serum VEGF, IL‑1 and TNF‑&alpha; in the treatment of thromboangiitis obliterans by revascularization

“…Usually, antiplatelet and vasodilator drugs are used for the treatment of TAO, these includes 5-HT2 receptor antagonists, prostaglandins, and vascular endothelin-1 receptor antagonists. Prostaglandin sodium and cilostazol are the widely used medications due to their good efficiency on TAO ( 7 , 8 ). There are also surgical treatment available to patients, such as endometrial ablation, vascular bypass, lumbar sympathectomy, balloon dilatation or catheter thrombolysis and amputation.…”