Thromboangiitis Obliterans Research Articles

Use of CO2 Arteriography in the follow-up of patients with Thromboangiitis Obliterans

Introduction: Thromboangiitis obliterans or Buerger's disease is a non-atherosclerotic, segmental and inflammatory vaso‐occlusive disease that appears mainly in medium and small sized arteries. Clinically, the most common manifestations are consistent with symptoms of ischemia of the lower extremities, intermittent claudication is the earliest onset sign [3]. An arteriography may be performed as a follow-up method in patients with long-standing disease and persistent symptomatology. With technological development, CO2 arteriography, approved by the FDA, has become an alternative to that performed with iodinated contrast, especially in patients hypersensitive to iodine or with compromised renal function as in our patient [6, 7]. Clinical case: A 62-year-old patient with a personal history of arterial hypertension, stage III renal disease and Thromboangiitis obliterans for 20 years. The patient comes to the control of his disease with symptoms characterized by intermittent claudication with a distance of 200 meters in the left lower limb. He continues with his smoking habit and states that he does not plan to stop. On physical examination, palpation of proximal pulses is normal, distal pulses are not palpable, but they are audible with sound Doppler in both extremities. Due to the progressive deterioration of vascular symptomatology, it was decided to perform an arteriography. Due to the reported allergy and renal pathology, CO2 arteriography was chosen, a procedure that was performed without complications. With the arteriographic findings, without the presence of stenosis requiring revascularization, it was decided to continue with the clinical treatment of the pathology and insisting on the elimination of the smoking habit. Conclusions: Treatment of Thromboangiitis Obliterans consists of eliminating the smoking habit; however, in patients who cannot meet this criterion due to different circumstances, periodic follow-up is recommended to determine if there is .......

A comprehensive review of the epidemiology and clinical features of 91 cases with Buerger's disease.

Thromboangiitis Obliterans (TAO) is a disease of small and medium-sized arteries with an unclear natural course. This study aims to establish a national registry of the disease to gain a better understanding of its epidemiology and clinical course. This study was a cohort study of 242 patients with a high probability of TAO admitted to Mashhad University of Medical Sciences (MUMS) hospitals from 2000 to 2015. Of these, 91 patients with a confirmed diagnosis were included in the study (90 males and 1 female) with a mean age of 35 ± 7.8years. The most common symptom upon onset of the disease was paresthesia (29.7%), followed by cold sensitivity and paresthesia (93.4%) during the progression of the disease and Raynaud syndrome or vasospasm (93.9%) in the active phase. The right lower limb was the most commonly affected limb (46.2%), and presenting ischemic symptoms in 48.4%.Statistics indicated a positive correlation between the duration of Burger's disease and the number of affected limbs (p = 0.001). There was no effect of disease duration on the likelihood of amputations (p = 0.28). Some patients may experience mild, subtle symptoms for years before the initial signs and symptoms appear, which can be severe and rapidly progress to the point of requiring amputation.We suggest that the diagnostic criteria for Buerger's disease should be revised in light of the presence of atherosclerosis and its associated risk factors, which present a challenge in terms of diagnosis and treatment. Clinical experience will be of great importance in this regard.

Effect of Surgical Sympathectomy in Patients Diagnosed with Thromboangiitis Obliterans Compared to Pharmacotherapy and Bypass Surgery

Background: Thromboangiitis obliterans (TAO) is a vasculopathy involving small and intermediate vessels of extremities with various medical and surgical treatment strategies. Objectives: This cohort study aimed to compare the outcomes of medical and surgical interventions in patients with TAO. Methods: Patients with a definite diagnosis of TAO were enrolled in the study and evaluated on the first day, as well as three and six months follow-up visits. A total of 70 patients with TAO were followed for 30 months. Improvements in the primary complaints (claudication of calves and soles, rest pain, paresthesia, thrombophlebitis migrans, gangrene, scars, Raynaud's phenomenon) were compared between the groups. Results: In terms of gender, 98.6% of participants were male. The mean age of the patients was 43.24± 9.8 years. Based on the results, 37 sympathectomy surgery, 11 amputation surgery, 15 bypass surgery, and 12 medical therapies with ILOPROST were considered for the patients (Medical treatment as combination therapy in patients with severe symptoms). The final results demonstrated that primary complaints were significantly improved in patients who underwent bypass surgery than in others. Conclusion: As evidenced by the obtained results, patients in our study significantly benefited more from bypass surgery than sympathectomy and pharmacotherapy

Validation of Gait Process Evaluation in People with Lower Limb Amputation

Objective: The gait process after lower limb amputation in a prosthesis is far from the original previously learned gait. In this paper, we present a simple method of observing and recording gait parameters. The proposed method was distinguished by the fact that gait measurement systems were permanently integrated into the prosthesis. The prosthesis became the measuring system in the study. Analysis of the parameters recorded in this way allows to unequivocally show the difference between correct gait and incorrectly realised gait in a lower limb prosthesis with high precision.Aim: The main objective of the study was to show the hallmarks of the gait process in amputees using a lower limb prosthesis (after the rehabilitation process and secondary learning of gait in a prosthesis) compared to the hallmarks of the gait process of a pre-amputee.Methods: Two people participated in the pilot study. One of them was scheduled for amputation surgery. The individual was selected using double-blind sampling from a patient base of 200 people, with Buerger's disease diagnosed at baseline. The second person underwent right lower limb amputation of the proximal third of the lower leg with a medium stump. The etiology of this amputation was Buerger's disease with necrosis of the foot with arterial congestion.Results: The results obtained in the pilot study showed that recording the loading pattern in the heel and forefoot is sufficient for unambiguous gait assessment. The obtained data allow the introduction of corrective measures in the positioning of the prosthesis, adapting it to the patient's anatomical gait style.Conclusion: The results of the study demonstrated that the analysis of foot movement can determine degree of gait correctness, and Dega's IV gait index as well as J.B. Saunders index can be the basis for evaluating gait correctness.

Thromboangiitis Obliterans Successfully Treated With Smoking-Cessation Instruction Including Passive Smoking Cessation

A 22-year-old man presented with recurrent pain and linear redness of the lower extremities for 1 year. He smoked 20 cigarettes daily for 6 years and did not report cannabis use. He was referred to the vascular department by his primary care physician. He had stopped smoking for 6 months to treat thromboangiitis obliterans, but his symptoms were recurrent. The patient was interviewed about smoking in his living environment. His family members and his colleagues were smokers. Therefore, we advised to avoid secondhand smoke as well. Consequently, his symptoms resolved within 2 weeks. He had no relapse at follow-up after 6 months.

A Systematic Review of the Effects of Smoking on the Cardiovascular System and General Health.

The main risk factor for atherosclerotic cardiovascular disease is smoking. Nicotine and carbon monoxide are two dangerous substances that are found in cigarette smoke. The increased heart rate can have an almost instantaneous impact on the heart and blood vessels. Smoking is well known to cause oxidative stress, endanger the lining of the arteries, and accelerate the accumulation of fatty plaque in the blood vessels. It raises the danger of sudden thrombotic events, inflammatory alterations, and low-density lipoprotein oxidation. The smoke's carbon monoxide decreases the blood's capacity to deliver oxygen, adding to the heart's stress. Notably, these risks increase when diabetes, hypertension, high cholesterol, and glucose intolerance are present. It has a detrimental effect on peripheral blood vessels, raising the possibility of thromboangiitis obliterans. Stroke risk is known to be increased by smoking. As compared to those who continue to smoke, those who give up smoking have a much longer life expectancy. Chronic cigarette smoking has been shown to affect the macrophages' ability to remove cholesterol. Abstinence from smoking enhances the function of high-density lipoproteins and cholesterol efflux, lowering the risk of plaque buildup. In this review, we present the most recent information regarding the causal relationship between smoking and cardiovascular health as well as the long-term advantages of quitting.

Buerger's Disease in the Testicle: A Case of Testicular Thromboangiitis Obliterans

Thromboangiitis obliterans (TAO), otherwise known as Buerger's disease, is a rare, non-atherosclerotic inflammatory vasculopathy that typically affects small and medium-sized arteries of the distal extremities. Smoking is believed to be integral to the pathogenesis, as TAO primarily affects young male smokers. The disease is characterized by extremity pain secondary to ischemia that may progress to ulceration, gangrene, and amputation. Involvement of the reproductive system is uncommon. Here, we offer a case of TAO presenting as a testicular mass lesion.

Jia-Wei-Si-Miao-Yong-An Fang stimulates the healing of acute radiation-induced cutaneous wounds through MAPK/ERK pathway.

A famous traditional oral Chinese medicine formula, Si-Miao-Yong-An decoction, has been used to treat thromboangiitis obliterans from the Qing Dynasty. Because its therapeutic principles including clearing away heat, detoxification, accelerating blood circulation and relieving pains are consistent with acute radiation-induced cutaneous wounds in traditional Chinese medicine, we tried to add herbs and improve them into an external dosage form, called Jia-Wei-Si-Miao-Yong-An Fang (JWSMYA). However, its mechanism on radiation-induced cutaneous wounds is still unknown. This study evaluated the therapeutic effect of JWSMYA and investigated the mechanism of repair and anti-fibrosis on acute radiation-induced cutaneous wounds with JWSMYA. Firstly, we prepared JWSMYA, and determined the composition through UHPLC LC-MS/MS. Then we used ionizing radiation to make a cutaneous wound model of rats, and observed wound healing through their skin injury score, wound contraction percentage and histological staining. In addition, immunohistochemical staining, Western blot analysis, qRT-PCR and Elisa were used to explore wound rehabilitation and anti-fibrosis mechanisms. An in vivo assay revealed that JWSMYA promoted the repairment of acute radiation-induced cutaneous wounds, facilitated MAPK/ERK phosphorylation, inhibited PI3K/AKT activation, reduced the level of alpha-smooth muscle actin (a-sma), collagen type-I alpha 2 (Col1a2) and transforming growth factor-beta 1 (TGF-β1) in cutaneous tissues. However, no statistical difference was found in vascular endothelial growth factor (VEGF). JWSMYA accelerated the repair of acute radiation-induced cutaneous wounds, which might be associated with the MAPK/ERK pathway. In addition, PI3K/AKT might be associated with the inhibition of fibrosis and the promotion of high-quality wound healing.

THROMBO ANGIITIS OBLITERANS- A CASE REPORT

Thrombo angiitis obliterans (TAO) is an inflammatory endarteritis associated with heavy tobacco use, affecting small and medium-sized arteries and veins of the upper and lower extremities, resulting in vaso - occlusion. Clinical features include pain, paraesthesia, moderate-to-severe claudication, paresis, and pulselessness. In Allopathy, pharmacologic or surgical therapy is not beneficial and amputation is considered the viable option.After an assessment of the patient and the disease, based on Ayurvedic principles, a treatment protocol was formulated. The treatment principles include the re-establishment of vascularity by the removal of occlusion (Srothorodhahara, Avaranahara), achieving normalcy of the tissue elements (Dhathu Samyatha), and pacification of the bioregulatory principles (Thridosha). Both purification (Sodhana) and pacification (Samana) treatment protocols were incorporated to achieve normalcy.A 65-year-old male patient was admitted and treated in the IPD of Dept. of Roganidana, Govt. Ayurveda College Thiruvananthapuram for Thrombo angiitis obliterans, with Ayurvedic medications and procedures. The signs and symptoms were completely relieved, and an arterial doppler study revealed normal vascularity of the affected limb.

Effects of Shock Wave Therapy on a Patient with Co-Occurring Vascular Congenital Malformation and Buerger's Disease

Effects of Shock Wave Therapy on a Patient with Co-Occurring Vascular Congenital Malformation and Buerger's Disease

Protective Effects and Potential Mechanism of Tongxinluo on Mice with Thromboangiitis Obliterans Induced by Sodium Laurate.

To investigate the effects of Tongxinluo (TXL) on thromboangiitis obliterans (TAO) and the underlying mechanisms. Ninety male C57/BL6J mice were randomly divided into 6 groups according to a random number table: the sham group, TAO model group, Compound Danshen Tablet (CDT) group, and the high-, medium-, and low-dose TXL groups. All mice except the sham group were injected with sodium laurate (0.1 mL, 5 mg/mL) in the femoral artery to establish TAO mouse model. After modeling, mice in the sham and TAO model groups were intragastrically administered 0.5% (w/v) sodium carboxymethylcellulose, mice in the CDT group were intragastrically administered 0.52 g/kg CDT, and mice in the TXL-H, TXL-M, and TXL-L groups were intragastrically administered 1.5, 0.75, and 0.38 g/kg TXL, respectively. After 4 weeks of gavage, the recovery of blood flow in the lower limbs of mice was detected by Laser Doppler Imaging. The pathological changes and thrombosis of the femoral artery were observed by morphological examination. The expressions of tumor necrosis factor α (TNF-α) and inducible nitric oxide synthase (iNOS) in the femoral artery wall were detected by HE staining. Levels of thromboxane B2 (TXB2), 6-keto-prostaglandin F1α (6-keto-PGF1α), endothelin-1 (ET-1), interleukin (IL)-1β and IL-6 were measured using enzyme-linked immunosorbent assay (ELISA). Levels of activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) and fibrinogen (FIB) were detected by a fully automated biochemical analyzer. TXL promoted the restoration of blood flow in the lower limbs, reduced the area of thrombosis in the femoral artery, and alleviated the pathological changes in the femoral artery wall. Moreover, the levels of TXB2, ET-1, IL-6, IL-1β, TNF-α and iNOS were significantly lower in the TXL groups compared with the model group (P<0.05 or P<0.01), while the level of 6-keto-PGF1α was significantly higher (P<0.01). In addition, APTT, PT, and TT were significantly prolonged in TXL groups compared with the model group (P<0.05 or P<0.01), and FIB levels were significantly decreased compared with the model group (P<0.01). TXL had a protective effect on TAO mice, and the mechanism may involve inhibition of thrombosis and inflammatory responses. TXL may be a potential drug for the treatment of TAO.

A 61-year-old with heavy tobacco use.

A 61-year-old female with a past medial history of type II diabetes controlled with metformin, peripheral upper and lower extremity neuropathy, right below knee amputation, and a 62-pack year smoking history presented to the emergency department complaining of a non-related chief complaint. However, on physical examination, her upper extremities were significant for nine previously amputated digits to the proximal interphalangeal joints and dry gangrene of the 2nd and 3rd digits of the left hand with necrotic eschars scattered over both hands. The patient endorsed multiple burns by cigarettes of unknown time frames in between the 2nd and 3rd digits (Figures 1 and 2). Thromboangiitis obliterans (Buerger's disease) is a nonatherosclerotic inflammatory disease of small and medium blood vessels strongly associated with tobacco use.1 Historically, this disease disproportionately affected men, but current trends show a rise in female diagnosis.2 Patients will often present with resting pain of the extremities and chronic necrotic eschars due to digital ischemia. Many patients have concurrent Raynaud's phenomenon.3 Diagnosis is based on either the Shionoya or Olin criteria.4, 5 Each of these criteria share features such as, but not limited to, onset before 45 (Shionoya) or 50 (Olin), history of or actively smoking, absence of other atherosclerotic risk factors, absence of connective tissue or autoimmune disease (Olin), and the absence of diabetes mellitus.6 Arteriographic findings are supportive but not diagnostic, such as collateral vessel corkscrewing without known atherosclerotic obstruction.7 Current treatment is smoking cessation.1 This patient had a previous diagnosis of thromboangiitis obliterans. She was found to be non-compliant with smoking cessation, smoking now 2 packs per day, up from the previously documented 1.5 packs per day. Smoking cessation education was provided. She is currently receiving treatment for cigarette burns of the 2nd and 3rd digit. A special thank you to our patient.

A COMPREHENSIVE STUDY OF CLINICAL PROFILE, RISK FACTORS AND TREATMENT OUT COME OF PERIPHERAL ARTERIAL DISEASES OF LOWER EXTREMITIES

Objectives: To study the pattern of clinical presentation, aetiology, various investigations for diagnosis and management of Peripheral arterial occlusive disease. This is a cross-sectional s Materials And Methods: tudy including 50 patients who presented to OPD at Government General Hospital, Anantapur, with Peripheral arterial occlusive disease. patients above the age of 18 years with symptoms of rest pain, claudication pain, ulceration and gangrene with evidence of lower limb arterial occlusive disease on doppler are included in this study. Patients less than 18 years of age and PAD of upper extremities, patients with history of trauma of lower extremities and pain due to musculoskeletal or neurological origin are excluded. The results of the Statistical Analysis: study are expressed in terms of proportion. In this study the most common etiological factor contributing for Peripheral arterial o Results: cclusive disease is atherosclerosis (76%) followed by thromboangiitis obliterans (24%). This disease has male preponderance and the most common age group affected is 41 years and above. The most common mode of presentation is rest pain and 50% of patients presented with gangrene affecting foot and lower 1/3rd of leg. The most common co-morbid condition associated with Peripheral arterial occlusive disease in this study is diabetes mellitus. Tobacco smoking is the most common addiction associated with Peripheral arterial occlusive disease. 45% patients with atherosclerosis showed involvement of infra-popliteal site. Almost all patients required surgical intervention due to the late presentation at tertiary care center. 66% of patients in this study required amputation. None of the patient died following amputation in this study.The cardiac evaluation showed abnormality in almost 20% of the study group. This emphasises the need for cardiac evaluation in all cases of peripheral arterial disease and this condition is called atherosclerosis. peripheral arterial disease is due Conclusion: to atherosclerosis in most of cases with male preponderance after 41 years and above with gangrene as the most common clinical presentation. Prompt surgical intervention in the form of amputation, reduced mortality rate.

Salvianolic acid A exerts a protective effect against sodium laurate induced thromboangiitis obliterans in rats

Purpose: To study the potential therapeutic effects of salvianolic acid A (Sal A) on thromboangiitis obliterans (TAO).&#x0D; Methods: An in vitro model of TAO-mimicking endothelial cell damage was established by incubating ECV304 cells with H2O2. An in vivo model of TAO rats was developed via injection of sodium laurate. After treatment with varying doses of Sal A, TAO symptoms were monitored over time and compared. The effects of Sal A on oxidative stress, pyroptosis, inflammation, and thrombosis were assessed using biochemical assays, enzyme-linked immunosorbent assay (ELISA), western blot, and histopathology.&#x0D; Results: Sal A significantly alleviated the inhibition of cell viability induced by H2O2 (p &lt; 0.05). The H2O2-induced increases in levels of ROS, IL-1β, and IL-18 in ECV304 cells were significantly decreased by Sal A (p &lt; 0.05). Moreover, Sal A alleviated TAO symptoms in rats. The enhanced levels of IL-1β, IL-18, NLRP3, and active Caspase-1 observed in TAO rats were reduced by Sal A in vivo (p &lt; 0.05). Moreover, Sal A significantly reduced the size of thrombus in TAO rats. In addition, upregulated levels of ROS were significantly inhibited by Sal A (p &lt; 0.05).&#x0D; Conclusion: Sal A exerts significant therapeutic effects on TAO. This provides mechanistic insights into the clinical effects of RSMA on TAO patients, which might be beneficial in the development of effective drugs against TAO in the future.

The Effect of Smoking Cessation on the Technical Success of Endovascular Treatment for Thromboangiitis Obliterans

PurposeTo show that smoking cessation improves the technical success of lower extremity endovascular treatment in patients with thromboangiitis obliterans (TAO), or Buerger disease. Materials and MethodsOne hundred two patients with TAO who underwent endovascular treatment for chronic limb-threatening ischemia or severe claudication of lower extremities in a tertiary hospital between 2015 and 2022 were included in this retrospective study. Data on serum cotinine levels were available for the last 45 patients, and 38 patients constituted the study population. Per the institution’s protocol, patients were instructed to quit smoking 15 days before the intervention. However, cotinine levels showed that some of the patients continued smoking. Technical and recanalization successes were assessed as the primary end points. The secondary end point was the improvement in Rutherford scores at the 1-month follow-up. The McNemar test was used to compare the proportion of recanalized arteries after the intervention. ResultsThirty-seven men and 1 woman (mean age, 42.9 years ± 10.1) were evaluated. The overall technical success rate was 86.8% in the study group. The technical success rate was significantly higher in the nonsmoker group (n = 24 [96%]) than in the smoker group (n = 8 [61.5%]; P = .006). One-month clinical data were available for 100% of the patients. The Rutherford category of the nonsmoker group was significantly lower at the 1-month follow-up. In addition, the Wilcoxon signed-rank test revealed lower Rutherford scores after the intervention in the nonsmoker group. The adverse event rate was 8%. One (2.7%) patient in the smoker group underwent a minor amputation. ConclusionsCessation of smoking before endovascular therapy improved technical success and recanalization rates in patients with TAO.

Integrated pharmacokinetics and pharmacometabolomics to reveal the synergistic mechanism of a multicomponent Chinese patent medicine, Mailuo Shutong pills against thromboangiitis obliterans

BackgroundMailuo Shutong Pills (MLST) have displayed pharmacological activity against thromboangiitis obliterans (TAO). However, the active ingredients and therapeutic mechanism of MLST against TAO remained to be further clarified. PurposeThe aim of this study was to explore the active components of MLST and their synergistic mechanism against TAO by integrating pharmacokinetics (PK) and pharmacometabolomics (PM). MethodsTAO model rats were established by sodium laurate solution. Firstly, the efficacy of MLST was evaluated by gangrene score, blood flow velocity, and hematoxylin-eosin (H&E) staining. Secondly, PK research was conducted on bioavailable components to characterize their dynamic behaviors under TAO. Thirdly, multiple plasma and urine metabolic biomarkers for sodium laurate-induced TAO rats were found by untargeted metabolomics, and then variations in TAO-altered metabolites following MLST treatment were analyzed utilizing multivariate and bioinformatic analysis. Additionally, metabolic pathway analysis was performed using MetaboAnalyst. Finally, the dynamic link between absorbed MLST-compounds and TAO-associated endogenous metabolites was established by correlation analysis. ResultsMLST significantly alleviated gangrene symptoms by improving the infiltration of inflammatory cells and blood supply in TAO rats. Significant differences in metabolic profiles were found in 17 differential metabolites in plasma and 24 in urine between Sham and TAO rats. The 10 bioavailable MLST-compounds, such as chlorogenic acid and paeoniflorin, showed positive or negative correlations with various TAO-altered metabolites related to glutamate metabolism, histidine metabolism, arachidonic acid metabolism and so on. ConclusionThis study originally investigated the dynamic interaction between MLST and the biosystem, providing unique insight for disclosing the active components of MLST and their synergistic mechanisms against TAO, which also shed light on new therapeutic targets for TAO and treatment.

CORRELATIONS OF ENDOGENOUS TESTOSTERONE AND DHEA-S IN PERIPHERAL ARTERIAL DISEASE

Background: Peripheral arterial disease is Occlusive disease of the arteries of the extremity. Common causes are Atherosclerosis (most common), Buerger's disease, vasculitis and other arteritis, thromboembolism etc. Peripheral arterial disease (PAD) is a treacherous disease as it remains asymptomatic for so long. As PAD progresses, it may lead to classical intermittent claudication and critical limb ischemia. DHEAS has been demonstrated to have an antiatherosclerotic effect by prevention of platelet aggregation, uptake of cholesterol and a decrease in the proliferation of vascular smooth muscle cells. Testosterone causes vasodilation of the peripheral arteries by acting on the endothelium of the vessels and in turn results in release of nitric oxide (NO) which is a vasodilator and helps in vasodilation. Testosterone suppresses expression of vascular cell adhesion molecule-1 (proinammatory cytokines), anti-inammatory factors by its derivative 5-dihydrotestosterone which is the earliest step in atherosclerosis. Interestingly Testosterone and DHEAS also has benecial effects on cardiac ischemia, angina and chronic heart failure. The aim of this study is to look for any relationship of Testosterone and DHEAS in Peripheral Arterial Disease. Total 50 patients both inpatients and out Methods: patients were studied. The period of study was from September 2016 to June 2018. Patients who were proven to have peripheral arterial disease on colour doppler were taken for study. The study was done to look if any relationship is present between serum testosterone and dehydroepiandrosterone sulfate (DHEA-S) in a peripheral arterial disease patients. Data were documented and stored in a proper database format. At the end of data collection from the samples, data analysis was done using SPSS 16 software and appropriate tests of signicance were applied. For categorical variables Chi-square test and Fischer's Exact test was used. For comparing two groups of mean student's t-test was used. To correlate more than two continuous data Pearson and Spearman Correlation Coefcient was used. P value &lt;0.05 considered as statistically signicant. Our results showed that total serum testosterone Results: and DHEA-S were not signicantly decreased in PAD patients in comparison to the control group. We could not observe any signicant correlation. These results express that there is no signicant correlation Conclusion: of Serum Testosterone and Dehydroepiandosterone with Peripheral arterial Disease. In our study there are signicant correlations with inammatory markers (C reactive protein, Interleukin6, Homocysteine) Lipid prole (cholesterol, Triglyceride, HDL, VLDL) and HbA1C with serum Testosterone and Dehydroepiandosterone in Peripheral Arterial Disease

Psychiatric sequelae of thromboangiitis obliterans: a case report and review of the literature

BackgroundPeripheral manifestations secondary to progressive vascular occlusions are characteristic of the rare condition termed thromboangiitis obliternas (TAO) or Buerger’s disease. The central manifestations of this disease are however poorly characterized, particularly those of psychiatric nature, and their prevalence is largely unknown. Speculations have been made around the polymorphic nature and triggers of observed psychopathology in TAO; much however remains to be unraveled in this area.Case presentationWe present the case of a 33-year-old Caucasian male who developed first episode of psychosis at the age of 29 years. There was no history of previous mental illness either in the patient, or in any of his family members. He had been a long- term heavy smoker and was experiencing progressive lower limb claudication since the age of 22 years; however, all inflammatory, autoimmune and atherosclerotic markers were negative. His psychosis was characterized by retention of a warm affect, and despite some amelioration, was generally resistant to a fair trial of several anti-psychotic medications including Clozapine.ConclusionThe pathophysiology of psychosis secondary to Buerger’s is not yet well characterized which adds to the complexity of managing these cases. Recognizing that cerebral manifestations of this disease may evolve several years after the onset of peripheral thromboangiitic features is important for following the natural history and considering measures that may reduce the burden of illness.

Relationship between COVID-19 Infection and Buerger's Disease-Related Amputations

Introduction: Thromboangiitis obliterans (TAO) or Buerger's disease is a non-atherosclerotic, inflammatory arteritis involving small and medium-sized arteries and veins of the extremities, often causing gangrene and scarring. Coronavirus disease (COVID-19) may predispose to both arterial and venous thromboembolic complications. This study examined the relationship between COVID-19 infection and Buerger's disease-related amputations. Materials and Methods: Between January 2018 and July 2023, 54 patients who applied to our clinic for Buerger's disease and were followed up and treated were analyzed retrospectively. Follow-up information, demographic data of patients (age, gender, body mass index (BMI), education status), when they were diagnosed, amount of smoking (pack/year), all treatments applied for Buerger's disease (Pre-Covid – Covid period – Covid Afterwards), presence or absence of limb amputation, continued smoking, medications, cardiovascular risk factors, Charlson Comorbidity Index (CCI), Venous Thromboembolic Event (Pulmonary Embolism), Covid-19 History and vaccination information were noted. Results: The mean age of 54 patients included in the study was 38.1 (27-49), all male. The mean smoking rate was 32 (16 - 60) packs/year, and the mean exposure to the SARS-CoV-2 virus was 1.22 (0-4) times. There was a significant correlation between major amputations due to Buerger's disease and age, severity of COVID-19 disease, and systemic hypertension (p&lt;0.005). Major amputation rates increased during the period of COVID-19 disease (p&lt;0.05). Conclusion: We found a statistically significant increase in major amputations as the exposure to the virus or the severity of the COVID-19 disease increased. We also observed a significant increase in major amputation rates in the presence of systemic hypertension. The presence of COVID-19 disease and hypertension should be considered when planning treatment to prevent amputation in Buerger's patients.

Do Patients With Arterial Occlusive Disease of Different Etiologies Benefit Equally From Cilostazol?

Cilostazol is a guideline-recommended drug that improves intermittent claudication and quality of life in patients with chronic atherosclerotic peripheral arterial disease. The drug is used for most etiologies of arterial occlusive diseases in clinical practice. This study aimed to evaluate whether patients benefit equally from cilostazol regardless of etiology. Patients on cilostazol were divided into 4 groups according to arterial occlusive disease etiology: (1) atherosclerosis, (2) diabetic angiopathy, (3) embolism/thrombosis, and (4) Buerger disease. Patients' maximum walking distance, ankle-brachial index score and distal tissue oxygen saturation (Sto2), clinical improvement onset time, ability to reach maximum benefit time, vascular surgeries, and wounds were compared before they started cilostazol and after 12 months. Results were evaluated at a statistical significance of P < .05. In 194 patients, 307 target extremities were evaluated in the 4 disease groups. After cilostazol use, maximum walking distance, ankle-brachial index score, and distal Sto2 increased significantly in all groups (P < .001), but distal Sto2 in the diabetic angiopathy and Buerger disease groups was significantly lower than in the atherosclerosis group (P < .001). Ankle-brachial index and distal Sto2 differences in the Buerger disease group were significantly lower (both P < .001). The vascular surgery counts decreased significantly in the atherosclerosis and embolism/thrombosis groups (P = .019 and P = .004, respectively). Patients with nonatherosclerotic arterial occlusive disease also benefit from cilostazol, but patients with Buerger disease or diabetic angiopathy seem to benefit less. Combining cilostazol with anticoagulant or antiaggregant agents and closer monitoring of these patients may produce better results.