Improvement in Blood Supply After “Heparin-Dextran” Therapy in Patients of Buerger’s Disease with Critical Limb Ischemia

Tromboangiitis obliterans (TAO) atau penyakit Buerger merupakan sindrom klinis yang ditandai dengan oklusi trombotik, non atherosklerotik, vaskulitis segmental pada arteri dan vena kecil dan sedang yang mengenai daerah ekstremitas atas maupun bawah. Inflamasi yang terjadi menyebabkan Critical Limb Ischemia. Dilaporkan seorang laki-laki, usia 33 tahun, mengalami nyeri pada ujung jari tangan dan kaki yang kemudian menghitam yang dirasakan sejak 3 minggu sebelumnya. Pasien mempunyai kebiasaan merokok 1 bungkus/hari selama 18 tahun. Pada pemeriksaan fisik ditemukan ujung-ujung jari kaki dan tangan menghitam, pulsasi arteri lengan dan tungkai masih teraba. Pada pemeriksaan doppler ultrasound didapatkan aliran darah arteri dan vena kedua tungkai dan lengan baik. Hasil arteriografi ekstremitas atas menunjukkan dinding arteri reguler, terdapat stenosis segmental pada arteria digitales dengan gambaran corkscrew. Arteriografi tungkai memperlihatkan morfologi arteri masih reguler, aliran arteri tidak sampai ke distal. Pasien didiagnosis Buerger’s Disease dan diberikan terapi cilostazol 2x50 mg, Nifedipin 2x10 mg, aspilet 1x80 mg, methilprednisolon 10 mg/8jam dan morfin sulfat 2x10 mg. Selama perawatan kondisi pasien membaik, nyeri ujung-ujung jari berkurang dan pasien dipulangkan. Satu minggu setelah pasien pulang, pasien mengeluhkan pembengkakan kaki sebelah kiri, ditemukan total trombus mengisi vena femoralis dan vena poplitea sinistra. Pasien kemudian dirawat untuk dilakukan heparinisasi. Penghentian merokok merupakan terapi definitif, penggunaan obat vasodilator, pentoksifilin dan cilostazol dapat membantu mengurangi gejala, namun tidak mencegah progresi penyakit.

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Phase IV postmarketing surveillance study shows continued efficacy and safety of stempeucel® in patients with critical limb ischemia due to Buerger's disease

Stem Cells Translational Medicine ◽

10.1002/sctm.21-0197 ◽

2021 ◽

Author(s):

Pawan Kumar Gupta ◽

Santanu Dutta ◽

Sanjay Kala ◽

Muralikrishna Nekkanti ◽

Sanjay C. Desai ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Surveillance Study ◽

Postmarketing Surveillance ◽

Efficacy And Safety ◽

Buerger’S Disease ◽

Buerger's Disease ◽

Postmarketing Surveillance Study ◽

Phase Iv

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Thrombolysis and angioplasty for acute lower limb ischemia in Buerger's disease

CardioVascular and Interventional Radiology ◽

10.1007/bf00203953 ◽

1994 ◽

Vol 17 (6) ◽

Cited By ~ 11

Author(s):

TimothyJ. Hodgson ◽

PeterA. Gaines ◽

JonathonD. Beard

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Buerger’S Disease ◽

Buerger's Disease ◽

Lower Limb Ischemia

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Marriage of resistance and conduit arteries breeds critical limb ischemia

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00773.2004 ◽

2005 ◽

Vol 288 (3) ◽

pp. H1044-H1050 ◽

Cited By ~ 28

Author(s):

Paul Coats ◽

Roger Wadsworth

Keyword(s):

Blood Supply ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Sudden Increase ◽

Large Artery ◽

Resistance Arteries ◽

Tissue Edema ◽

Surgical Bypass ◽

Small Resistance ◽

And Function

Atherosclerosis in a major leg artery leads to impaired blood supply, which normally progresses to critical limb ischemia. Atherosclerosis produces substantial alterations of structure and endothelial function in the large conduit arteries. Pressure unloading and ischemia in the distal vasculature bring about alterations in microvascular function. Resistance arteries undergo significant wall thinning and changes in their contractile regulation. Optimization of large artery dimensions by the small arteries through flow-mediated vasodilation is impaired. Angiogenesis is stimulated, which can result in the formation of major collateral feeder vessels in addition to small nutritive blood vessels. However, angiogenesis can also contribute to instability of atherosclerotic plaques, which ultimately leads to further deterioration in blood supply. Surgical bypass grafting to restore blood supply to the distal leg generates a sudden increase of pressure in the weakened resistance vasculature, leading to uncontrolled changes in capillary hydrostatic pressure, extravasation of fluid, and tissue edema. This review aims to highlight the importance of the resistance vasculature in critical limb ischemia and the interdependence of pathophysiological changes in the large conduit and small resistance arteries. The major unresolved question is why the physiological mechanisms that regulate vascular structure and function ultimately break down, leading to circulatory failure within the distal limb.

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Prolonged regional analgesia in the complex treatment of extensive purulent-necrotic wounds on the background of decompensated arterial and venous insufficiency (case report

Wounds and wound infections The prof B M Kostyuchenok journal ◽

10.25199/2408-9613-2019-6-3-34-43. ◽

2020 ◽

Vol 6 (3) ◽

pp. 34-43

Author(s):

S. A. Orudzheva ◽

L. A. Blatun ◽

S. V. Sokologorskiy ◽

M. A. Sheina ◽

T. G. Turova ◽

...

Keyword(s):

Sciatic Nerve ◽

Blood Supply ◽

Critical Limb Ischemia ◽

Lower Limb ◽

Limb Ischemia ◽

Complex Treatment ◽

Intense Pain ◽

Arterial Blood Supply ◽

Arterial Blood

Objective: to demonstrate the successful complex treatment of a shin circular wound in a patient with intense pain due to critical limb ischemia and wound infection, which became possible against the background of prolonged peripheral blockade. Materials and methods. A 72-year-old patient with critical ischemia of the right lower extremity was treated for a circular purulent-necrotic wound of the shin leg from November 2016 to April 2017 at the Wounds and Wound Infections Department of FSBI “A. V. Vishnevsky NRC of Surgery” Ministry of Health of Russia. An examination revealed the impossibility of right lower limb arterial insufficiency surgical correction. The patient refused amputation of the lower limb. For the relief of pain, a long-term blockage of the sciatic nerve was used (infusion of ropivacaine 6.0–8.0 mg / hr into the perineural catheter, additional 100 mg ropivacaine boluses were used before performing traumatic daily dressings). The intensity of pain was evaluated on a visual analogue scale (VAS), sought to achieve a pain intensity of not more than 3 points at rest and not more than 4 points on – when moving. Results. Blockade of the sciatic nerve reduced the intensity of pain from 8–10 to 0–3 points, which made it possible to continue treatment. In total, the duration of sciatic nerve catheterization at the stages of treatment was 115 days (18 + 41 + 23 + 32), the maximum duration of one of the peripheral nerve catheterizations was 41 days. Complications associated with nerve catheterization were not observed in the patient. The pain syndrome is stopped, the area of the wound defect is reduced in size. Discharged for outpatient treatment. Conclusion. Long-term peripheral analgesia made it possible to gain time necessary for cleansing the wound surface from necrotic tissues, therapy with drugs that improve arterial blood supply to the limbs, as well as for performing reconstructive and reconstructive operations after the wound process has passed to the reparative stage. Long-term peripheral blockade is a prerequisite for the successful treatment of extensive wounds of the lower extremities caused by insufficient arterial blood supply at the stage of critical limb ischemia, accompanied by intense pain.

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Arterial collateral circulation pathways in patients with aortoiliac occlusive disease

Vascular ◽

10.1177/1708538119859795 ◽

2019 ◽

Vol 27 (6) ◽

pp. 677-683

Author(s):

Ioannis Katsaros ◽

Efstratios Georgakarakos ◽

Konstantinos Frigkas ◽

Kalliopi-Maria Tasopoulou ◽

Vasileios Souftas ◽

...

Keyword(s):

Intermittent Claudication ◽

Blood Supply ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Occlusive Disease ◽

Arterial Blood Supply ◽

Aortoiliac Occlusive Disease ◽

Iliac Arteries ◽

Arterial Blood ◽

Collateral Pathways

Objectives Aortoiliac occlusive disease is a leading cause of morbidity and mortality worldwide. Patients typically present with intermittent claudication or critical limb ischemia but the majority of them remain asymptomatic. Collateral arterial pathways restore the arterial blood supply distal to the lesions. The objective of this study is the description of collateral pathways’ patterns of aortoiliac occlusive disease. Methods Records from the Department of Vascular Surgery of University General Hospital of Alexandroupolis were retrospectively searched from March 2016 to August 2018 for patients suffering from aortoiliac occlusive disease. Results Thirty-three patients (24 males, 9 females) with a mean age of 64.2 ± 11.8 years were included in this study. Twenty-two patients had diabetes mellitus, 25 hypertension, and 16 dyslipidemia. Twenty-two were active smokers. Seventeen patients suffered from intermittent claudication and 16 patients presented with critical limb ischemia. Seven patients had TASC-II B lesions, 10 TASC-II C lesions, and 16 patients had TASC-II D lesions. Systemic collateral pathways were dominant in 17 patients, whereas visceral pathways were prominent in 16 patients. While 62.5% of patients having lesions in the abdominal aorta presented systemic pathways, the lesions located only in the iliac arteries followed visceral patterns or systematic patterns equally. Conclusions Collateral anastomotic networks provide blood supply to regions distal to aortoiliac occlusive lesions. Their pattern is defined mainly by the location of the lesion and does not seem to associate with comorbid factors or the extent of the lesion. Failure to recognize these networks during surgery could lead to limb threatening situations.

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Management of Buerger's Disease in Endovascular Era

International Journal of Angiology ◽

10.1055/s-0039-1685200 ◽

2019 ◽

Vol 28 (03) ◽

pp. 173-181 ◽

Cited By ~ 2

Author(s):

Baker M. Ghoneim ◽

Ahmed G. Karmota ◽

Ahmed M. Abuhadema ◽

Ahmed A. Shaker ◽

Hany M. Abdelmawla ◽

...

Keyword(s):

Clinical Improvement ◽

Limb Ischemia ◽

Transluminal Angioplasty ◽

High Rate ◽

Thromboangiitis Obliterans ◽

P Value ◽

Buerger’S Disease ◽

Buerger's Disease ◽

Surgical Bypass ◽

Report Data

AbstractThis 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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