How to Treat a Patient with Thromboangiitis Obliterans: A Systematic Review

Fazeli, Bahare; Moghadam, Maliheh Dadgar; Niroumand, Shabnam

doi:10.1016/j.avsg.2017.10.022

Cited by 38 publications

(31 citation statements)

References 36 publications

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“…Interestingly, only one study was found comparing oxidative stress and antioxidant defenses in WBD vs. atherosclerotic peripheral arterial occlusive disease, reporting that the oxidative balance is more seriously impaired in WBD patients [30,51]. Additionally, we confirmed that the level of oxidants is greater in WBD patients than the antioxidant capacity in healthy smokers and non-smokers, supporting/strengthening the hypothesis of both a biochemically enhanced and clinically impairment of oxidant/antioxidant balance in Winiwarter-Buerger disease [8,51]. Interestingly, the production of ROS from intracellular and extracellular sources may affect both endothelial cell morphology and function; thus, also promoting the expression of adhesion molecules, which may represent pro-inflammatory signals and increase the risk of thrombosis [61].…”

Section: Discussionsupporting

confidence: 78%

“…WBD is characterized as a nonatherosclerotic thrombotic occlusive peripheral vascular disease, affecting arteries and veins with the presence of highly inflammatory thrombus [47][48][49]. Although strongly associated to the use of tobacco and cannabis products use, per se, are not justifying the well described oxidative stress responsible for the progression and worsening of this disease, sadly suggesting that little progress has been made in the understanding of its pathophysiology and treatment [4,8,50].…”

Section: Discussionmentioning

confidence: 99%

“…Although a significant relationship between smoking (both tobacco and cannabis products) and progression of WBD has been identified [5], smoking per se cannot explain the prevalence and distribution of this harmful vascular disease [6]. Despite efforts in previous years and advances in medical therapy [4,7,8], WBD patients may actually benefit only by blocking smoking habits (abstinence of all tobacco/cannabis product use) and through targeted endovascular therapy, effective for preserving limb loss/amputation, and useful for accelerating the healing process in Buerger's ischemic ulcers [9].…”

Section: Introductionmentioning

confidence: 99%

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The Imbalance among Oxidative Biomarkers and Antioxidant Defense Systems in Thromboangiitis Obliterans (Winiwarter-Buerger Disease)

Sharebiani

Fazeli

Maniscalco

et al. 2020

JCM

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(1) Background: Thromboangiitis obliterans or Winiwarter-Buerger disease (WBD), is an inflammatory, thrombotic occlusive, peripheral vascular disease, usually occurring in young smokers. The pathophysiological mechanisms underlying the disease are not clearly understood. The aim of this study is to investigate the imbalance between oxidants and antioxidants occurring in these patients. (2) Patients and Methods: In this cross-sectional study, 22 male patients with WBD and 20 healthy male smoking habit matched control group were included. To evaluate the possible sources of oxidative stress, the antioxidant biomarkers, and the markers of lipid peroxidation and protein oxidation, serum samples were analyzed for total oxidative status (TOS), total antioxidant capacity (TAC), myeloperoxidase (MPO), coenzyme Q10 (CoQ10), superoxide dismutase (SOD), glutathione reductase (GR), malondialdehyde (MDA), and protein carbonyl (PC) activity and/or content. (3) Results: The circulating levels of TOS, TAC, and CoQ10 were significantly higher in WBD patients, with respect to healthy smokers as controls. No significant difference was found among the serum level of PC, total cholesterol, MPO, and GR activity in WBD patients and healthy smoker controls. The activity of SOD and the mean serum level of MDA were significantly lower in WBD patients, with respect to healthy smoker controls. (4) Conclusion: Considerably high levels of oxidative stress were detected in WBD patients, which were greater than the antioxidant capacity. The low level of MDA may be associated with the enzymatic degradation of lipid peroxidation products. High levels of CoQ10 and low levels of SOD may be related to a harmful oxidative cooperation, leading to the vasoconstriction of WBD, representing a promising tool to discern possible different clinical risks of this poorly understood peripheral occlusive disease.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Imbalance among Oxidative Biomarkers and Antioxidant Defense Systems in Thromboangiitis Obliterans (Winiwarter-Buerger Disease)

Sharebiani

Fazeli

Maniscalco

et al. 2020

JCM

Self Cite

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“…Additionally, this disease is common in young and middle age population with consequent long-term disability. 7 The recommended treatment to decrease the possible risk factors, particularly smoking; however, smoking cessation is an extremely difficult option in these patients and it will not be sufficient in patients with CLI. Consequently, different treatment approaches have been applied for TAO including antiplatelet, immunesuppressant, vasodilators, lumbar sympathectomy, bypass surgery, and endovascular angioplasty.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is lack of agreement on the best approach and there are no data about efficacy and cost of these treatment in TAO. 7 There are several challenges in managing this disease. Firstly, the cause of disease is still unknown and formulating adequate treatment is not possible until the cause of disease is determined.…”

Section: Discussionmentioning

confidence: 99%

Management of Buerger's Disease in Endovascular Era

et al. 2019

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This study was aimed to report data on the feasibility, safety, and effectiveness of endovascular procedures in a thromboangiitis obliterans diagnosed patients presenting with critical limb ischemia (CLI). Prospective study conducted on patients affected by Buerger's disease who presented to our center along 2 years. Clinical, radiological, and patient-based outcomes were recorded at 3, 6, and 12 months after the intervention. Total 39 patients were included in the study. Fifteen (38.5%) patients underwent percutaneous transluminal angioplasty, another 15 patients (38.5%) underwent follow-up on medical treatment, there are four other patients (10.3%) underwent surgical bypass, and five (12.8%) patients underwent lumbar sympathectomy. The 12 months' outcome showed 66.7% technical success in endovascular group with 46.7% patency rate (p-value = 0.06), 86.7% limb salvage rate (LSR; p-value < 0.04), and 66.7% clinical improvement (p-value = 0.005). The endovascular management of Buerger's disease is feasible, save, and effective with high rate of LSR and clinical improvement.

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