Galyfos George, Kerasidis Stavros, Kastrisios Georgios, Giannakakis Sotirios, Sachmpazidis Ioannis, Anastasiadou Christiana, Geropapas Georgios, Papapetrou Anastasios, Papacharalampous Gerasimos, Maltezos Chrisostomos
1 Department of Vascular Surgery, KAT General Hospital, Kifissia, Greece.
Vasa. 2017 Oct;46(6):471-475. doi: 10.1024/0301-1526/a000649. Epub 2017 Jul 28.
Proper management of patients with thromboangiitis obliterans (TAO) or cannabis-associated arteritis (CAA), presenting with critical lower limb ischaemia (CLI) remains controversial, and data are limited.
Patients with TAO or CAA presenting with CLI between 2011 and 2016 were retrospectively evaluated. Patients requiring primary intervention were excluded. Conservative treatment included: (a) weight-adjusted bemiparin plus six hours/day intravenous iloprost for 28 days, (b) aspirin (100 mg/day) plus cilostazol (100 mg twice/day) after discharge, and (c) strict recommendations/monitoring for smoking cessation. Main outcomes included symptom recession, ankle-brachial index (ABI) improvement, and healing of lesions at the time of discharge as well as amputation, revascularization, and abstinence rate during follow-up.
Overall, 23 patients (TAO: 15; CAA: 8) were included within six years, none of the patients reported any other factor than smoking. All patients presented with rest pain and 12 patients with ulcer or necrotic lesions. Mean ABI measurement at presentation was 0.46 ± 0.2, after 28 days of treatment, all patients showed improvement regarding clinical picture and ABI measurement (0.54 ± 0.1; p < 0.05). During follow-up, only three patients underwent bypass surgery and two patients underwent major amputation, although the smoking abstinence rate was very low (13 %).
Intravenous iloprost plus bemiparin for 28 days together with per os aspirin plus cilostazol seem to produce promising results in patients with TAO/CAA, treated for CLI, even with a low smoking abstinence rate. However, larger series are needed to further evaluate inter-group differences and potential prognostic factors.
对于血栓闭塞性脉管炎（TAO）或大麻相关性动脉炎（CAA）伴严重下肢缺血（CLI）患者的恰当管理仍存在争议，且数据有限。
对2011年至2016年间出现CLI的TAO或CAA患者进行回顾性评估。排除需要进行初次干预的患者。保守治疗包括：（a）根据体重调整剂量的贝米肝素加每天6小时静脉输注伊洛前列素，共28天；（b）出院后服用阿司匹林（100毫克/天）加西洛他唑（100毫克，每日两次）；（c）严格建议/监测戒烟情况。主要结局包括症状缓解、踝肱指数（ABI）改善、出院时病变愈合情况以及随访期间的截肢、血管重建和戒烟率。
6年间共纳入23例患者（TAO：15例；CAA：8例），所有患者除吸烟外未报告任何其他因素。所有患者均有静息痛，12例患者有溃疡或坏死性病变。就诊时ABI测量的平均值为0.46±0.2，治疗28天后，所有患者的临床症状和ABI测量值均有改善（0.54±0.1；p<0.05）。随访期间，仅3例患者接受了搭桥手术，2例患者接受了大截肢手术，尽管戒烟率很低（13%）。
对于接受CLI治疗的TAO/CAA患者，静脉输注伊洛前列素加贝米肝素28天，再加上口服阿司匹林加西洛他唑似乎能产生较好的效果，即使戒烟率较低。然而，需要更大规模的系列研究来进一步评估组间差异和潜在的预后因素。
