Improvement in Blood Supply After "Heparin-Dextran" Therapy in Patients of Buerger's Disease with Critical Limb Ischemia

Abstract

Alleviating the agonizing pain of critical limb ischemia (CLI) in patients of Buerger's disease (BD) has been challenging, due to lack of definitive treatment; "Heparin-Dextran" infusion has been tried in this study. Assessment of clinical improvement and vascular changes following therapy. Patients with CLI admitted to emergency surgical ward were studied prospectively. BD was diagnosed by Shionoya's criteria, and confirmed by digital subtraction angiography (DSA). Heparin and Dextran intravenous infusion was administered for 10 days. Severity of rest pain, ischemic changes in the feet, claudication distance and ankle brachial index (ABI) were estimated prior to therapy, at completion and 3 weeks after therapy. Vascular changes were assessed by CT angiography (CTA) performed prior to and 3 weeks after therapy. Twenty consecutive patients were studied. Successful hemodilution reflected by decreased hematocrit (37.4 % to 32.6 %, p < 0.05) and increased mean ABI (0.46 to 0.83, p < 0.01), improved rest pain in 75 % patients (p < 0.001), increased claudication distance in 94 % (p < 0.05) and ulcers healing in 70 % patients. CTA revealed recanalised vessels (decreased length of occluded segments) in 10 (50 %, p = 0.005), increased collaterals in 12 (60 %, p < 0.01) and improved distal run-off in 13 (65 %, p < 0.01) patients. "Heparin-Dextran" therapy in patients of CLI from BD improves tissue perfusion by increasing collaterals and recanalisation of vessels, resulting in significant relief from rest pain and clinical improvements. CTA is as efficacious as DSA for evaluation of BD.

Keywords: Angiography; Buerger’s disease; Critical limb ischemia; Heparin-Dextran.

Fig. 1

Upper panel—a DSA of a patient showing occlusion of left femoropopliteal artery (white arrow, partial occlusion; red arrow, complete block); b network of minute corkscrew collaterals (white arrows), without reformation of distal vessels; lower panel—c CTA of a patient showing 12.42 cm thrombosed segment of femoropopliteal artery, without significant collateral and poor distal runoff; d CTA 3 weeks after therapy in the same patient, showing partial recanalization (occluded segment 4.89 cm), with increased collaterals and improved distal runoff

Fig. 2

Graphical presentation: decreasing intensity of rest pain (mean NRS score) with “heparin–dextran” therapy

Fig. 3

A bar chart showing correlation of clinical and CTA improvements after therapy