OBJECTIVE: To investigate the effects of Tongxinluo (TXL) on thromboangiitis obliterans (TAO) and the underlying mechanisms. METHODS: Ninety male C57/BL6J mice were randomly divided into 6 groups according to a random number table: the sham group, TAO model group, Compound Danshen Tablet (CDT) group, and the high-, medium-, and low-dose TXL groups. All mice except the sham group were injected with sodium laurate (0.1 mL, 5 mg/mL) in the femoral artery to establish TAO mouse model. After modeling, mice in the sham and TAO model groups were intragastrically administered 0.5% (w/v) sodium carboxymethylcellulose, mice in the CDT group were intragastrically administered 0.52 g/kg CDT, and mice in the TXL-H, TXL-M, and TXL-L groups were intragastrically administered 1.5, 0.75, and 0.38 g/kg TXL, respectively. After 4 weeks of gavage, the recovery of blood flow in the lower limbs of mice was detected by Laser Doppler Imaging. The pathological changes and thrombosis of the femoral artery were observed by morphological examination. The expressions of tumor necrosis factor α (TNF-α) and inducible nitric oxide synthase (iNOS) in the femoral artery wall were detected by HE staining. Levels of thromboxane B2 (TXB2), 6-keto-prostaglandin F1α (6-keto-PGF1α), endothelin-1 (ET-1), interleukin (IL)-1β and IL-6 were measured using enzyme-linked immunosorbent assay (ELISA). Levels of activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) and fibrinogen (FIB) were detected by a fully automated biochemical analyzer. RESULTS: TXL promoted the restoration of blood flow in the lower limbs, reduced the area of thrombosis in the femoral artery, and alleviated the pathological changes in the femoral artery wall. Moreover, the levels of TXB2, ET-1, IL-6, IL-1β, TNF-α and iNOS were significantly lower in the TXL groups compared with the model group (P<0.05 or P<0.01), while the level of 6-keto-PGF1α was significantly higher (P<0.01). In addition, APTT, PT, and TT were significantly prolonged in TXL groups compared with the model group (P<0.05 or P<0.01), and FIB levels were significantly decreased compared with the model group (P<0.01). CONCLUSIONS TXL had a protective effect on TAO mice, and the mechanism may involve inhibition of thrombosis and inflammatory responses. TXL may be a potential drug for the treatment of TAO.
Mice ; Male ; Animals ; Thromboangiitis Obliterans/chemically induced* ; Interleukin-6/metabolism* ; Tumor Necrosis Factor-alpha/metabolism* ; Thrombosis

No abstract available.
Thromboangiitis Obliterans ; Transplants ; Veins

In thromboangiitis obliterans (Buerger's disease), little progress has been made in its treatment. Medical treatment is ineffective and bypass surgery is possible only in limited case. Nowadays, endovascular intervention is popular treatment option for Buerger's disease. Endovascular procedure is safe, technically feasible, and effective. Especially, in long occlusion lesion with distal channel, endovascular intervention can be an effective treatment option. Herein, we report a case of complete wound healing following the successful endovascular intervention in Buerger's disease patient with distal channel.
Catheterization, Peripheral ; Endovascular Procedures ; Humans ; Ischemia ; Thromboangiitis Obliterans* ; Wound Healing

OBJECTIVETo evaluate the long-term clinical effect of autologous peripheral blood mononuclear cells (PB-MNC) on critical limb ischemia (CLI) in patients with thromboangiitis obliterans (TAO) patients.

METHODSThe clinical data of 22 patients with CLI caused by TAO from July 2004 to May 2013 were analyzed retrospectively, 22 patients were divided into 2 groups; out of them 12 cases in one group were treated with granulocyte colony-stimulating factor (G-CSF)-mobilized autologous peripheral blood mononuclear cells (auto-PBMNC group), 10 cases in another group received conservative treatment (CT group). The log-rank test was used to compare the long-term outcomes in auto-PBMNC group and CT group.

RESULTSThe wound healing rate (P=0.016) and CLI-free rate (P=0.013) were significantly higher in PB-MNC group compared with that in CT group. No difference was found in amputation rates between the 2 groups (major amputation: P=0.361, minor and major amputation: P=0.867). No patients died or no serious adverse events occurred during the follow-up period.

CONCLUSIONThe auto-PBMNC therapy can significantly promote the wound healing, and protect against CLI in TAO patients, but the risk of amputation is not low in comparison with conservative treatment.

Amputation ; Extremities ; physiopathology ; Granulocyte Colony-Stimulating Factor ; pharmacology ; Humans ; Ischemia ; therapy ; Leukocytes, Mononuclear ; transplantation ; Retrospective Studies ; Thromboangiitis Obliterans ; therapy ; Transplantation, Autologous ; Treatment Outcome ; Wound Healing

We reported a patient with Buerger's disease who presented with critical limb ischemiawith prior recurrent occlusions after multiple surgical and endovascular treatments. Total occlusion of the whole native femoropopliteal and infrapopliteal arteries was observed. The femoropopliteal bypass graft, as well as a stent that was implanted in the mid-popliteal artery, were also occluded. Because of the lack of distal targets for bypass, surgical revascularization was not feasible; therefore, we decided to perform endovascular treatment. To overcome the limitation of vascular access, the previously implanted popliteal stent was directly punctured, and a guide wire was passed through the bypass graft. After the organized thrombus in the bypass graft was aspirated, further recanalization below the popliteal stent down to the plantar arteries was performed successfully. In conclusion, the stent puncture technique is a feasible and safe option for overcoming the limitations of vascular access in patients with multilevel occlusions.
Arteries ; Endovascular Procedures ; Extremities ; Humans ; Peripheral Arterial Disease ; Punctures* ; Stents* ; Thromboangiitis Obliterans* ; Thrombosis ; Transplants

Buerger’s disease (BD) or thromboangiitis obliterans is a vasculitis that most commonly affects the small and medium-sized arteries and veins in the extremities.1 It is most frequently seen in the young men who smoke and is associated with low socioeconomic status. BD is diagnosed on the basis of the clinical findings; the pathogenesis is not completely be understood.1-4 In this report, we aim to present the clinical, magnetic resonance imaging (MRI) and angiographic findings of a 30-year-old man with ischemic stroke as a rare complication of BD.
Thromboangiitis Obliterans

Surgical revascularization for patients with Buerger's disease is possible only in a few cases, due to the diffuse segmental involvement and the lack of distal runoff vessels available for bypass surgery. We encountered a case of resting pain in the right foot, coldness with dysesthesia, and cyanosis on the right 1st toe. The patient was treated with an endovascular intervention after vein patch angioplasty failed due to an inflammatory reaction of Buerger's disease. We suggest that an endovascular procedure can be an effective treatment, even in addition to more conservative and surgical management, in patients with Buerger's disease and critical limb ischemia.
Angioplasty* ; Cyanosis ; Endovascular Procedures ; Extremities ; Foot ; Humans ; Ischemia ; Paresthesia ; Thromboangiitis Obliterans* ; Toes ; Veins

No abstract available.
Arterial Occlusive Diseases/complications/*diagnosis/radiography ; Hemorrhage ; Humans ; Ileal Diseases/radiography/surgery ; Ileocecal Valve/blood supply ; Infarction/pathology/*surgery ; Male ; Mesenteric Artery, Superior/*radiography ; Middle Aged ; Thromboangiitis Obliterans/complications/*diagnosis ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Half of patients with critical limb ischemia (CLI) are ineligible for revascularization at diagnosis. The aim of this study was to assess the safety and feasibility of intramuscular human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) therapy in patients with CLI due to atherosclerosis obliterans (ASO) or thromboangiitis obliterans (TAO). METHODS AND RESULTS: A total of eight patients (all male, median age 52 years, range 31~77) with CLI were enrolled in this phase I trial. All patients were considered ineligible for further revascularization to improve CLI. We injected 1x10(7) hUCB-MSCs per single dose intramuscularly into the affected limb. The primary end points of safety were occurrence of adverse events (procedure-related complication, allergic reaction to hUCB-MSCs, graft-versus-host disease, cardiovascular and cerebrovascular events) and improvement of symptoms/clinical parameters (healing of foot ulcer, ankle-brachial index, and pain-free walking distance). Angiogenesis was measured with conventional angiography and scored by an independent reviewer. There were four adverse events in three patients. One patient, developed whole body urticaria after injection on treatment day, which disappeared after one day of antihistamine treatment. The other adverse events included diarrhea, oral ulceration, and elevation of serum creatinine level; all conditions improved without treatment. Abnormal results of laboratory parameters were not detected in any patients. Three of four ulcerations (75%) healed completely. Angiographic scores increased in three of eight patients. CONCLUSIONS: This phase I study demonstrates that intramuscular hUCB-MSC injection is a safe and well tolerated treatment for patients with end-stage CLI due to ASO and TAO.
Angiography ; Ankle Brachial Index ; Arterial Occlusive Diseases ; Atherosclerosis ; Creatinine ; Diarrhea ; Extremities ; Fetal Blood ; Foot Ulcer ; Graft vs Host Disease ; Humans ; Hypersensitivity ; Ischemia ; Male ; Mesenchymal Stromal Cells ; Oral Ulcer ; Oxalates ; Stem Cells ; Thromboangiitis Obliterans ; Troleandomycin ; Ulcer ; Umbilical Cord ; Urticaria ; Walking

OBJECTIVESTo summarize the outcome of revascularization for lower limbs thromboangiitis obliterans (TAO) and evaluate risk factors affected outcomes.

METHODSBetween January 2008 and December 2011, a consecutive series of 24 TAO patients with lower limb ischemia were underwent revascularization. All the patients were male. The mean age was (33 ± 6) years (24-43 years). All patients presented with history of heavy smoking.Fifteen patients (62.5%) presented with ulcer or gangrene, 7 cases (29.2%) presented with rest pain, the rest 2 cases (8.3%) presented with severe intermittent claudication.Eight cases underwent bypass, including 6 autogenous vein graft, 1 prosthesis graft and 1 hybrid graft; 7 cases underwent catheter-directed thrombolysis combined with angioplasty; 3 cases underwent angioplasty and stenting directly; the rest 6 cases underwent thromboectomy and/or endarterectomy. The technical success, amputation and patency of target vessel were reported.Some risk factors were evaluated by multi-factors regression analysis to identify whether influenced outcomes.

RESULTSSeventeen cases (70.8%) harvested primary technical success. Three cases (12.5%) suffered with major amputation due to failure of revascularization.Eight cases with bypass all were successful, 4 cases with thrombolysis got success, 2 cases with primary angioplasty and stenting got success, while the 3 cases with thromboemctomy and/or endarterectomy got success. Among the 7 failed cases, 3 cases needed major amputation, 2 cases underwent re-operation, and the rest 2 cases got conservation treatment. All the patients had effective follow-up between 1 and 40 months (mean (17 ± 11) months).No death occurred during the follow-up. Primary patency, secondary patency and limb salvage rate were 45.8% (11/24), 62.5% (15/24), and 79.2% (19/24), respectively.Risk factors regression analysis showed patients with ulcer or gangrene before revascularization got significant worse outcomes (Wald = 4.018, P = 0.043) . Bypass could improve outcomes significantly (Wald = 4.016, P = 0.045) .

CONCLUSIONSOutcomes of revascularization for TAO with lower limb severe ischemia are acceptable. Autogenous vein graft bypass should be first choice. Thrombolysis with angioplasty could be a reasonable choice for those had no satisfied autogenous vein graft.

Adult ; Angioplasty, Balloon ; Endarterectomy ; Follow-Up Studies ; Humans ; Lower Extremity ; blood supply ; Male ; Retrospective Studies ; Thromboangiitis Obliterans ; surgery ; Treatment Outcome ; Vascular Surgical Procedures