Improvement in Blood Supply After "Heparin-Dextran" Therapy in Patients of Buerger's Disease with Critical Limb Ischemia.
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.
Departments of General Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, 160 012 India.
Sanand
S
Bag
Departments of General Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, 160 012 India ; Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012 India.
Arunanshu
A
Behera
Departments of Radiology and Imaging Sciences, Post Graduate Institute of Medical Education & Research, Chandigarh, 160 012 India.
Niranjan
N
Khandelwal
Departments of Radiology and Imaging Sciences, Post Graduate Institute of Medical Education & Research, Chandigarh, 160 012 India.
J R
JR
Bapuraj
Departments of Histopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160 012 India.
Rakesh Kumar
RK
Vasishta
Angiography; Buerger’s disease; Critical limb ischemia; Heparin-Dextran