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.