Treatment of thromboangiitis obliterans (Buerger's disease) with high-potency vasodilators

Abstract

Thromboangiitis obliterans (TAO) or Buerger's disease is a vascular inflammatory thrombotic occlusive and segmental disease affecting distal small and medium-sized arteries of the limbs. Tobacco is the main trigger factor and avoiding it is the main treatment. Frequently, it is necessary to use high-potency vasodilators, such as iloprost, bosentan, sildenafil, or alprostadil, to relieve symptoms and reduce the risk of amputation. Iloprost is the only one that has been shown to be effective in randomized clinical trials. We report the third case of TAO treated with sildenafil and a new case treated with bosentan. This condition can be diagnosed and treated by a dermatologist. We would like to highlight the excellent clinical response despite the fact that patients continued to smoke. This finding may have important therapeutic implications because early treatment may prevent amputation and can be effective even during the process of giving up smoking.

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

“…Many diff erent vasodilating agents have been proposed for acute management of patients with TAO, although iloprost is the only one that has been evaluated in randomized trials. Intravenous (IV) iloprost has been recommended as a fi rst-line treatment [21] and there are recent data suggesting that it may lead to good results even without smoking cessation, concurring with our results as well [22]. In a recent systematic review, evaluating fi ve randomized trials [23], IV iloprost has been found to be superior to aspirin or even per os iloprost, concerning symptoms recession and ulcer healing in patients with TAO.…”

Thromboangiitis obliterans: A rare case report

“…Arteriography is the main diagnostic test and biopsy is rarely indicated. [1,7,8] These patients have a high risk of disability and amputation. [8] In a study described a risk of amputation of 11 to 23%.…”

Efficacy of bosentan in patients with refractory thromboangiitis obliterans (Buerger disease)

“…[3] More recently, bosentan has been introduced in refractory cases of TAO, bringing in a new alternative for prolonged oral treatment. [9–15] …”

“…[4,9–15,17] After evaluation of the full text, 2 of these articles were excluded because they were reviews. [4,17] In addition, we excluded 7 of the 19 cases reported by De Haro et al [11] because their clinical characteristics were not sufficiently detailed to be individually analyzed.…”

“…[8] Based on these findings, bosentan—a competitive antagonist of ET-1 at the endothelin-A (ET-A) and endothelin-B (ET-B) receptors—is beginning to be used in severe and refractory cases of TAO, and has effectiveness and a good safety profile. [9–15] …”