Treatment of Thromboangiitis Obliterans with Intermittent Claudication of Extremities
In patients with Thromboangiitis obliterans (Buerger disease), intermittent claudication of the extremities substantially limits walking tolerance and functional capacity. Choosing the right pharmacological strategy in this setting requires matching the agent to the patient's symptom profile.
Clinical Scenario
This protocol is for Thromboangiitis obliterans presenting with intermittent claudication of the extremities — exercise-induced limb pain that forces the patient to stop and rest, reflecting insufficient peripheral perfusion during exertion.
Treatment Approach
The structured regimen involves oral pharmacological agents selected to improve peripheral blood flow and extend walking tolerance. Agent selection varies according to whether vasospasm is identified as a contributing factor.
Treatment Goal
The primary clinical objective is increased pain-free walking distance, directly improving functional independence and quality of life.
References
- DOI: 10.1155/2013/156905
- Other drugs that have been proven beneficial in TAO patients with intermittent claudication are naftidrofuryl (Praxilene), levocarnitine, arginine, buflomedil, ketanserin, niacin, and lovastatin.
- Though usage of pentoxyfylline may increase the pain-free walking distance in many, the long-term benefit and improvement in quality of life is limited.
- A dose of verapamil up to 480 mg/day can be given as an adjuvant therapy to patients.
- A dihydropyridine calcium channel blocker, such as amlodipine or nifedipine, seems to be effective if vasospasm is present.
- In a study by Bagger et al. increasing doses of verapamil was used in 44 patient of TAO; it was seen that there was an increased mean pain-free walking distance by 29% from 44.9 to 57.8 meters.
- Patient have to be informed beforehand and possibly starting with a lower dose, such as 50 mg once a day, then after approximately 1 week increasing to 50 mg twice a day and then increasing to the recommended dosage of 100 mg twice a day may alleviate most of these headaches.