Which pharmacologic therapies are used in the treatment of thromboangiitis obliterans (TAO) (Buerger disease)?

Updated: Jul 27, 2020
  • Author: Naiem Nassiri, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Intravenous (IV) iloprost (a prostaglandin analogue), an expensive agent unavailable in the United States, appears to be somewhat effective in improving symptoms, accelerating resolution of distal-extremity trophic changes, and reducing the amputation rate among patients with TAO. [18] IV iloprost therapy is probably most useful for slowing progressive tissue loss and reducing the need for amputation in patients with critical limb ischemia during the period when they first discontinue cigarette smoking.

The use of thrombolytic agents to treat TAO has been proposed, but the data to support this proposal remain inconclusive, and the therapy is thus considered experimental. Isner et al reported that improved healing of ischemic ulcers and relief of rest pain was achieved in a small series of TAO patients by using intramuscular gene transfer of vascular endothelial growth factor (VEGF). [19]

Oral nonsteroidal anti-inflammatory drugs (NSAIDs) and narcotic analgesics can be administered to palliate ischemic pain, and appropriate oral antibiotics can be used to treat mild distal extremity ulcers.

Aside from the experimental use of iloprost and thrombolytics, the use of antibiotics to treat infected ulcers, and the palliative treatment of ischemic pain with NSAIDs and narcotics, all other forms of pharmacologic treatment have been generally ineffective in the treatment of TAO, including steroids, calcium-channel blockers, reserpine, pentoxifylline, vasodilators, antiplatelet drugs, and anticoagulants.


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