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This study analyzes the therapeutic effects of intravenous infusion of iloprost in wound healing, healing of the amputation stump wound, improvement in intermittent claudication and prevention of major amputation in patients with Buerger's disease.
In a prospective study, 19 patients with known Buerger's disease, received intravenous iloprost infus...
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... were from dif- ferent locations of Iran and had a history of this ill- ness for 6 months to 10 years. Their chief complaints varied from burning rest pain in the lower extremities, to discoloration of the limbs, intermittent claudica- tion, and toe necrosis or amputation stump gangrene (Figure 1). In 9 patients, popliteal pulse was not palpable in the affected limb. ...
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The results of surgical approaches are unsatisfactory in patients with a distal arterial bed that is ineligible for revascularization. In this retrospective study, we investigated outcomes in patients who underwent surgical interventions that are reported to induce angiogenesis.
6 patients diagnosed with thromboangiitis obliterans were included in...
Buerger's disease or thromboangiitis obliterans (TAO) seems to be common in IR Iran, The present study aimed to evaluate an Iranian population with Buerger's disease in order to suggest a diagnostic criterion for Buerger's disease based on the most frequent findings and to compare it with Papa diagnostic criteria. In a cross-sectional study, all pa...
Background: Thromboangiitis obliterans is a disease of unknown aetiology seen under 45 years of age with no form of treatment has been successful in offering the victims of this disease a cure nor even a long-term remission. Objective of the study was to study the role of different risk factors, clinical features and treatment modality in early det...
Citations
... It affects and obstructs small and medium arteries and veins, and may result in loss of tissue or of the limb. Although the etiology and pathophysiology of the disease have not been fully clarified yet, it has been associated with immunological malfunction, hypersensitivity to smoking, and hereditary predisposition [3][4][5][6]. Buerger's disease affects primarily males, between 20-50 years of age, with a current or recent history of smoking, however an increasing occurrence in women has recently been observed that is probably attributed to an increase in smoking among females. The disease's progression and prognosis has been associated with smoking. ...
... The disease's progression and prognosis has been associated with smoking. Smoking has also been closely related to the appearance and recurrence of the disease [3][4][5][6][7], thus abstinence from smoking is crucial for the prevention of disease onset and progression [8]. ...
Background: Buerger's disease is a non-atherosclerotic inflammatory angiopathy, characterized as inflammatory endarteritis. It affects small and medium size arteries and veins of the upper and lower extremities, and is often associated with high amputation rates.
... 15 Another study in 19 patients with TAO concluded that intravenous iloprost therapy did not demonstrate significant changes in wound healing during the treatment and at discharge. 16 In aggregate, the efficacy results shown by iloprost when used for the management of TAO are not completely satisfactory. ...
Buerger's disease or thromboangiitis obliterans is a type of obstructive vascular diseases categorized as vasculitis and usually present in 95% of young smoker men. The main pathogenetic mechanism is interplay between immune system and inflammation. Earlier our phase II study has shown that stempeucel are safe when injected at 2 million cells/kg body weight by virtue of its anti-inflammatory, immunomodulatory, and angiogenetic properties. The present study was conducted to further assess the safety and efficacy of stempeucel in critical limb ischemia due to Buerger's disease after obtaining approval from Indian FDA based on the data generated in the phase II study. This is an open label, multicenteric phase IV PMS study conducted across India with experienced vascular surgeons. Fifty patients of critical limb ischemia due to Buerger's disease with Rutherford III-5 or III-6 were included in the study and each individual received a dose of 2 million cells/kg body weight of stempeucel in the calf muscles and around the ulcer. These patients were evaluated over 12 months from drug administration. The present study showed the continued long term efficacy over a period of 12 months follow up in these patients corroborating the result obtained in the previous phase II studies. There was significant improvement in rest pain, ankle systolic pressure, and ankle brachial pressure index with accelerated ulcer healing. In conclusion, the present study shows that the intramuscular administration of stempeucel continues to be safe, tolerable, and effective alternative treatment in patients with Buerger's disease.
... Some of the most prevalent regions with TAO include Asian and the Middle East. Furthermore, recent reports have indicated that Iran has an increased prevalence of TAO compared to western countries (3,4). The primary risk factor for TAO is understood to be smoking (5), As the majority of patients with TAO have a history of smoking that results in the development of vasospasm and a hypercoagulable state (6). ...
Background:
Thromboangiitis obliterans (TAO), also known as Burger's disease, is a devastating disease affecting the arteries and veins of the upper and lower distal limbs most commonly afflicting young male smokers of low socioeconomic status. The expression of human leukocyte antigen (HLA)-A, B and -DRB1 genes have been implicated in the pathogenesis of TAO. Our study aimed to examine the association of different HLA-A, B and -DRB1 genes in TAO patients in the Iranian population.
Methods:
A case-control study examining 55 Iranian patients with TAO and 500 healthy subjects was performed in Imam Reza hospital, Mashhad, Iran. The prevalence of major histocompatibility complex (MHC) class I (-A, -B) and class II (-DRB) alleles were determined for each participant.
Results:
Our results revealed the HLA-A*03 (odds ratio [OR]=5.394), HLA-A*24 (OR=5.143), HLA-A*31 (OR=4.251), HLA-A*11 (OR=3.034), HLA-B*27 (OR=6.680), HLA-B*15 (OR=3.959), HLA-B*07 (OR=3.698), HLA-B*51 (OR=3.370), HLA-B*44 (OR=3.326), HLA-DRB1*16 (OR=20.583), HLADRB1* 04 (OR=8.960), HLA-DRB1*14 (OR=3.746), HLA-DRB1*03 (OR=2.303), and HLA-DRB1*15 (OR=2.111) alleles to occur at a significantly higher frequency in TAO patients compared to controls (p<0.05). The HLA-A*25, HLA-A*66, HLA-DRB1*08, HLA-DRB1*10, and HLA-DRB1*12 alleles resulted in infinite OR, and was associated with an increased risk of TAO. However, the alleles HLA-A*30, HLA-B*08, HLA-B*45, HLA-B*46, and HLA-B*53 were associated with a protective role against TAO with an OR = 0.
Conclusion:
This is the first study examining the HLA pattern in patients with Burger's disease in the Iranian population. Our findings have revealed an association between HLA class I and II alleles with TAO.
... The disease progresses to critical limb ischemia (CLI), manifested clinically as rest pain, incurable ulceration, gangrene, and toe or limb loss. Because the possibility of vascular bypass is usually small as a result of diffuse segmental involvement and the distal nature of the disease [2], the consequence of the disease in the more advanced stage may be limb amputation, especially of the lower extremities [3]. Consequently, there is increasing ongoing research on the use of additional interventions for therapeutic angiogenesis, such as cell-based therapy [4][5][6][7][8][9], gene therapy [10,11] and immunoabsorption therapy [12] in these "no option" patients with CLI. ...
Significance:
Critical limb ischemia (CLI) due to Buerger's disease presents a major unmet medical need. The limited therapeutic options lead to increased morbidity and mortality. This study showed that use of adult human bone marrow-derived, cultured, pooled, allogeneic mesenchymal stromal cells is safe and efficacious when the cells are injected intramuscularly at a dose of 2 million cells/kg body weight in patients with CLI. Rest pain and ulcer healing significantly improved in most patients. This regimen may be a novel therapeutic option for Buerger's disease.
... The disease progresses to critical limb ischemia (CLI), manifested clinically as rest pain, incurable ulceration, gangrene, and toe or limb loss. Because the possibility of vascular bypass is usually small as a result of diffuse segmental involvement and the distal nature of the disease [2], the consequence of the disease in the more advanced stage may be limb amputation, especially of the lower extremities [3]. Consequently, there is increasing ongoing research on the use of additional interventions for therapeutic angiogenesis, such as cell-based therapy [4][5][6][7][8][9], gene therapy [10,11] and immunoabsorption therapy [12] in these "no option" patients with CLI. ...
... The disease progresses to critical limb ischemia (CLI), manifested clinically as rest pain, incurable ulceration, gangrene, and toe or limb loss. Because the possibility of vascular bypass is usually small as a result of diffuse segmental involvement and the distal nature of the disease [2], the consequence of the disease in the more advanced stage may be limb amputation, especially of the lower extremities [3]. Consequently, there is increasing ongoing research on the use of additional interventions for therapeutic angiogenesis, such as cell-based therapy [4][5][6][7][8][9], gene therapy [10,11] and immunoabsorption therapy [12] in these "no option" patients with CLI. ...
... Farmacoterapia: Los fármacos utilizados en Enfermedad de Buerger van dirigidos al manejo del dolor, prevención de trombosis en casos agudos y tratamiento de lesiones infectadas (2) . Algunos medicamentos específicos para mejorar la perfusión distal en estos pacientes han sido estudiados, entre ellos, el Iloprost ® , análogo sintético de la prostaglandina 12, que produce vasodilatación, previene la liberación de gránulos plaquetarios y síntesis de tromboxano A2, que ha demostrado mejorar el dolor en reposo y mayor curación de úlceras isquémicas y reducción en la necesidad de amputación (3,16) . Sin embargo en el Consenso TASC II, los expertos concluyen con respecto al uso de prostanoides en isquemia crítica de la extremidad, que la predicción de respuesta es difícil y no se cuenta con evidencia reciente que apoye su uso en la promoción de la sobrevida libre de amputación (17) . ...
... Sin embargo en el Consenso TASC II, los expertos concluyen con respecto al uso de prostanoides en isquemia crítica de la extremidad, que la predicción de respuesta es difícil y no se cuenta con evidencia reciente que apoye su uso en la promoción de la sobrevida libre de amputación (17) . Un estudio reciente, en Irán, demostró que la terapia con Iloprost ® no mostró mejoría significativa en la curación de las heridas al momento del egreso, pero sí mostró efectos tardíos (según el seguimiento a dos años plazo) en la cicatrización del muñón de amputación, la distancia sin claudicación y en la prevención de amputación mayor (16) . También se ha estudiado el efecto de la terapia inmunosupresora con ciclofosfamida, demostrando mejoría clínica y disminución de la inflamación en hallazgos histopatológicos (disminución de linfocitos y células plasmáticas en la pared arterial y el trombo) (18,19) . ...
Thromboangiitis obliterans also known asBuerger’s Disease is a segmental, inflammatory,occlusive, non-atherosclerotic disease that involves small and medium caliber arteries, veinsand nerves; affects mainly young males withtobacco abuse history.The clinical presentation is caused for the occlusion and stenosis of the distal vasculature in upper and lower limbs. The initial ischemicsymptoms are intermittent claudication in theaffected extremities. In the natural history of thedisease, patients can present severe ischemia ofthe limbs (rest pain, ulcers, and digital gangrene).Arteriographic studies show a pattern of abruptocclusion of the distal vasculature, with areas ofnormal vessels between the affected segments,with intense tortuosity in the recanalized segments described in a “corkscrew shape”. Thehistology varies according to the phase of thedisease but usually and occlusive intraluminalthrombus with lymphocytes, giant cells, inflammation of the media and the adventitia with aninternal elastic lamina unaffected. The key oftreatment is to eliminate the smoking but alsosome pharmacologic and surgical approacheshave been established as well as new therapiesunder trials.
Oxidative stress (OS) has been identified as a key factor in the development of Thromboangiitis Obliterans (TAO). The detection of OS levels in clinical and scientific research practice is mainly based on the measurement of oxidative stress such as reactive oxygen species (ROS), reactive nitrogen species (RNS) and lipid peroxides. These markers are typically assessed through a combination of physical and chemical methods. Smoking is known to the state of OS in TAO, and OS levels are significantly increased in smokers due to inadequate antioxidant protection, which leads to the expression of apoptotic proteins and subsequent cell injury, thrombosis and limb ischemia. There, understanding the role of OS in the pathogenesis of TAO may provide insights into the etiology of TAO and a basis for its prevention and treatment.
Background: Iloprost, prostacyclin (PGI2) analogue, effective in treatment of peripheral arterial disease, secondary Raynaud's phenomenon (RP) to connective tissue disease (CTD), vasculitis, pulmonary hypertension, is usually infused through peristaltic pump, or recently through a flow regulator. Materials and methods: We tested a new portable syringe pump (Pompa Infonde ®, Italfarmaco S.p.A., Cinisello Balsamo, Milano) on 120 patients affected by RP to CTD and cryoglobulinaemia, in iloprost therapy with a flow regulator. Results: Iloprost infused through portable syringe pump is better tolerated, better appreciated by the patients and nurses and no difference was observed on therapeutic effects, with a lower incidence of side effects statistically significant. Only 3 patients were unable to tolerate the device (2 for changes in pressure and 1 for fear) and shifted to traditional method of iloprost infusion. Conclusions: Iloprost infusion through the portable syringe Pompa Infonde® appears to be safe, better tolerated, more acceptable and equally effective compared to infusion through a flow regulator.
We assessed the effectiveness of iloprost treatment in the management of symptomatic Buerger disease (BD) and assessed smoking cessation compliance, based on a single-center experience. Thirteen patients with BD were treated with sessions of intravenous (IV) Ilomedin infusion. At 1-year follow-up, pain status alteration, number of analgesics required, ankle-brachial index (ABI) change, compliance with supervised smoking cessation, and amputation-free rate were recorded. The pain status improved considerably according to a visual analog scale, the number of analgesics required was significantly reduced, and all patients improved their pain-free walking distance, the ABI, and their self-reported quality of life. Only 2 patients required minor amputations. Combination of IV Ilomedin infusion, supervised smoking cessation, and a specific follow-up protocol may lead to improvement in pain-free walking distance, pain status, quality of life, and substantial reduction in amputation risk.
