Evaluation of the Vascular Effects of Iloprost in Patients with Thromboangiitis Obliterans (Buerger’s Disease)

Abstract

Objective: Thromboangiitis obliterans (TAO) is a common vascular pathology that occurs as a result of increased cigarette smoking in individuals with a genetic predisposition. Due to the incomplete understanding of its pathogenesis, the condition's diagnosis, treatment, and prevention processes still present challenges. Methods: In this study, 15 patients (1 female, 14 male), aged between 20 and 55, diagnosed with TAO, were treated with iloprost, a stable PGI2 analogue. Each patient received intravenous iloprost for six hours daily over 28 days. The dose titration was as follows: treatment started with 0.5 ng/kg/min for the first three days. The dose was increased by 0.5 ng/kg/min every 30 minutes until a maximum dose of 2.0 ng/kg/min was reached and maintained for six hours. Before and after treatment, 20 mCi Tc-99m pyrophosphate injections were administered, and lower extremity perfusion rates were assessed through scintigraphy in both resting and exercising positions. A significant increase in perfusion rates was observed after treatment (p<0.05). Results: In this study, iloprost treatment accelerated ischemic ulcer healing, increased walking distance, alleviated pain at rest, and improved the ankle-brachial index in patients with TAO. These positive effects of treatment persisted for up to six months. Changes before and after treatment were statistically significant, as shown both subjectively and scintigraphically (p<0.05). Conclusion: The aim of this study was to evaluate the effect of PGI2 analogues, such as iloprost, on tissue perfusion reserve in patients with TAO at the microvascular level using scintigraphy.

Keywords

• iloprost
• thromboangiitis obliterans
• scintigraphy
• prostacyclin (pgi2)