How is Thromboangiitis Obliterans treated?
a) Complete discontinuation of smoking or tobacco use in any form including nicotine replacements. (Many patients continue to smoke despite disease severe enough to result in amputation.) Stop smoking!
b) Treatment of local ischemic ulceration.
• Wound care (wound debridement and moist dressings, negative pressure wound therapy for open wounds, etc.).
• Trial of calcium channel blockers and/or pentoxifylline.
• Iloprost (helps patients with critical limb ischemia get through the period when they first discontinue smoking).
• Sympathectomy usually of limited benefit but helpful in some patients.
• Other approaches: bosentan, bone marrow mesenchymal stem cells, fibroblast growth factors, granulocyte colony-stimulating factor, and hepatocyte growth factor have been effective in case reports and series.
c) Treat cellulitis with antibiotics.
d) Treat superficial phlebitis with nonsteroidal antiinflammatory drugs.
e) Amputate limb when all else fails. Over 50% of patients who continue to smoke require amputations.
