How to Treat a Patient with Thromboangiitis Obliterans: A Systematic Review

Area of Science:

• Vascular Surgery
• Clinical Medicine
• Evidence-Based Medicine

Background:

• Thromboangiitis obliterans (TAO) is a rare inflammatory disease affecting small and medium-sized arteries and veins, often leading to critical limb ischemia (CLI).
• Existing treatment protocols for TAO patients with CLI, including smoking cessation, are insufficient for limb salvage.

Purpose of the Study:

• To systematically review and evaluate various treatment protocols aimed at preventing amputation in patients with TAO and CLI.
• To identify the efficacy of current interventions based on available scientific literature.

Main Methods:

• A systematic literature search was conducted across PubMed, SCOPUS, and Science Direct databases for studies published between 1990 and 2016.
• Inclusion criteria were applied, resulting in the selection of 24 studies.
• Only one randomized controlled trial (RCT) was identified; the rest were quasi-experimental, precluding meta-analysis.

Main Results:

• No reviewed treatment protocol demonstrated significant effectiveness in reducing major amputation rates for TAO patients with CLI.
• The available evidence is limited, with a scarcity of high-quality research, particularly RCTs.

Conclusions:

• There is a critical need for well-designed, standard randomized controlled trials to establish effective treatment strategies for TAO-related CLI.
• Further research into cost-benefit and cost-efficacy analyses of potential treatments is recommended, considering international variations in health insurance coverage.