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Erschienen in:
01.08.2011 | Original Paper
Successful treatment of thromboangiitis obliterans (Buerger’s disease) with immunoadsorption: results of a pilot study
Erschienen in: Clinical Research in Cardiology | Ausgabe 8/2011
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Background
No established therapy is available for patients with thromboangiitis obliterans (TAO) and critical limb ischemia. Since abnormalities of the immune system appear to be involved in the pathogenesis, we investigated in this pilot study the efficiency of Ig immunoadsorption (IA) therapy.
Methods
Ten patients with advanced TAO underwent a single IA course over five consecutive days. Before IA angiography was performed. In addition, the following were conducted prior to IA, directly after, as well as 1, 3, and 6 months after IA: clinical examination, pain scale (0–10), treadmill test for evaluation of maximum walking distances, and several angiological methods for evaluation of disease extent: photoplethysmography, ultrasound Doppler, and transcutaneous assessment of partial carbon dioxide (\( {\text{tc}}P_{{{\text{CO}}_{2} }} \)) and oxygen (\( {\text{tc}}P_{{{\text{O}}_{2} }} \)) pressure.
Results
Immunoadsorption treatment was tolerated without side effects. Pain intensity decreased rapidly from 7.7 ± 0.8 (mean ± SEM) before treatment to 2.0 ± 1.2 at the second day of IA. One month after IA, all patients were without pain. This functional amelioration persisted over the follow-up period of 6 months. Correspondingly, maximum walking distances significantly increased from 301.7 ± 191.4 to 727.0 ± 192.7 m immediately after IA, and further continuously up to 1,811.0 ± 223.7 at 6 months after IA. Healing of ischemic ulcerations was observed in all patients during follow-up. \( {\text{tc}}P_{{{\text{CO}}_{2} }} \) and \( {\text{tc}}P_{{{\text{O}}_{2} }} \) values as well as photopletysmographic data that were severely compromised before IA reflecting reduced tissue oxygenation and perfusion showed rapid amelioration reaching normal values at 1 month.
Conclusion
Anti-Ig IA appears to be an effective therapeutic option for patients with advanced TAO.