Intra-Arterial Nitroglycerin Injection in Upper Extremity Buerger's Disease for Faster Ulcer Recovery: A Case Report

Abstract

Thromboangiitis obliterans (TAO), also known as Buerger's disease, is a challenging nonatherosclerotic vascular disorder predominantly affecting smokers. Current management of TAO lacks standard guidelines, with smoking cessation as the only cornerstone. We present the case of a 28-year-old smoker with TAO manifesting as necrotic finger ulcers. Regardless of initial debridement, conventional therapy failed to improve his condition. Angiography confirmed the diagnosis of TAO and intra-arterial nitroglycerin injection was administered, leading to immediate vasodilation and improved perfusion. Combined with oral vasodilators and anticoagulants, the patient showed significant ulcer healing within 2 weeks. TAO's etiology remains unclear; however, it is linked to smoking and immune responses. Diagnosis relies on clinical criteria and angiographic findings. While smoking cessation remains crucial, various pharmacological interventions like vasodilators show considerable potential for enhancing therapeutic outcomes. Our case highlights the potential of intra-arterial nitroglycerin in TAO management. However, further studies are warranted due to limited sample size. Advancements in understanding TAO's biology and diagnostic techniques offer hope for improved management strategies in the future.

Keywords

thromboangiitis obliterans - Buerger's disease - smoking - angiography - intra-arterial - nitroglycerin - vasodilator

Publikationsverlauf

Artikel online veröffentlicht:
22. Juli 2024

• References

• 1 Jiménez-Gallo D, Albarrán-Planelles C, Arjona-Aguilera C, Blanco-Sánchez G, Rodríguez-Mateos ME, Linares-Barrios M. Treatment of thromboangiitis obliterans (Buerger's disease) with high-potency vasodilators. Dermatol Ther 2015; 28 (03) 135-139
• 2 Hartmann P, Mohokum M, Schlattmann P. The association of Raynaud syndrome with thromboangiitis obliterans: a meta-analysis. Angiology 2012; 63 (04) 315-319
• 3 Rivera-Chavarría IJ, Brenes-Gutiérrez JD. Thromboangiitis obliterans (Buerger's disease). Ann Med Surg (Lond) 2016; 7: 79-82
• 4 Uyanık SA, Öğüşlü U, Aminu IS. et al. Endovascular treatment of critical limb ischemia in Buerger disease (thromboangiitis obliterans) with midterm follow-up: a viable option when bypass surgery is not feasible. AJR Am J Roentgenol 2021; 216 (02) 421-427
• 5 Dargon PT, Landry GJ. Buerger's disease. Ann Vasc Surg 2012; 26 (06) 871-880
• 6 Bozkurt AK, Köksal C, Demirbas MY. et al; Turkish Buerger's Disease Research Group. A randomized trial of intravenous iloprost (a stable prostacyclin analogue) versus lumbar sympathectomy in the management of Buerger's disease. Int Angiol 2006; 25 (02) 162-168
• 7 Sawan ZH, Soliman M, Ezzat A, Mostafa A, Kamel RA. A review on nitroglycerin: present and future. Egypt J Hosp Med 2018; , 2023; 91 (01) 4972-4974
• 8 Maniskas ME, Roberts JM, Trueman R. et al. Intra-arterial nitroglycerin as directed acute treatment in experimental ischemic stroke. J Neurointerv Surg 2018; 10 (01) 29-33
• 9 Zheng JF, Chen YM, Chen DY, Lin CH, Chen HH. The incidence and prevalence of thromboangiitis obliterans in Taiwan: a nationwide, population-based analysis of data collected from 2002 to 2011. Clinics (São Paulo) 2016; 71 (07) 399-403
• 10 Matsushita M, Nishikimi N, Sakurai T, Nimura Y. Decrease in prevalence of Buerger's disease in Japan. Surgery 1998; 124 (03) 498-502
• 11 Bérard AM, Bedel A, Le Trequesser R. et al. Novel risk factors for premature peripheral arterial occlusive disease in non-diabetic patients: a case-control study. PLoS One 2013; 8 (03) e37882
• 12 Choi B, Jang SY, Kim SK, Kim N, Kim K, Kim DK. The incidence, prevalence, and survival rate of thromboangiitis obliterans in Korea: a retrospective population-based study. Cardiovasc Diagn Ther 2020; 10 (05) 1238-1244
• 13 Zheng P, Wang W. Etiology and Pathogenesis of Buerger's Disease. In: Mourad Aribi. ed. Probing Selected Autoimmune Diseases for Focused Perspectives. London:: IntechOpen; 2024
• 14 Şahin S. Thromboanjitis obliterans (Buerger's disease). Dent Med J-Rev 2022; 4 (01) 79-89
• 15 Bogacz R, Gaik M, Uram E. et al. Thromboangiitis obliterans (Buerger's disease): a review. J Educ Health Sport 2023; 36 (01) 124-134
• 16 Fazeli B, Ligi D, Keramat S, Maniscalco R, Sharebiani H, Mannello F. Recent updates and advances in Winiwarter-Buerger disease (thromboangiitis obliterans): biomolecular mechanisms, diagnostics and clinical consequences. Diagnostics (Basel) 2021; 11 (10) 1736
• 17 Shionoya S. What is Buerger's disease?. World J Surg 1983; 7 (04) 544-551
• 18 Mills Sr JL. Buerger's disease in the 21st century: diagnosis, clinical features, and therapy. Semin Vasc Surg 2003; 16 (03) 179-189
• 19 Graziani L, Morelli L, Parini F. et al. Clinical outcome after extended endovascular recanalization in Buerger's disease in 20 consecutive cases. Ann Vasc Surg 2012; 26 (03) 387-395
• 20 Bozkurt AK, Cengiz K, Arslan C. et al. A stable prostacyclin analogue (iloprost) in the treatment of Buerger's disease: a prospective analysis of 150 patients. Ann Thorac Cardiovasc Surg 2013; 19 (02) 120-125
• 21 Aledari M, Alzamili R, Kadim M, Alwan AM, Afshari JT, Darban RA. Thromboangiitis obliterans or Buerger's disease: important characteristics. J Pharm Negat Results 2023; 14 (01) 232-248
• 22 Jaroonwanichkul S, Hall JC. Decreasing tobacco use promotes ulcer healing in a patient with Buerger's disease. Clin Case Rep 2023; 11 (02) e6999
• 23 Firat A, Igus B. Endovascular recanalization of thromboangiitis obliterans (Buerger's disease) in twenty-eight consecutive patients and combined antegrade-retrograde intervention in eight patients. Cardiovasc Intervent Radiol 2019; 42 (06) 820-828