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N Hati K Izan M G Lenny S Krishna K Azim I H Harunarashid

Abstract

INTRODUCTION

Buerger’s Disease is a segmental inflammatory occlusive disorder of unknown aetiology affecting the upper limb and lower limb. It is also known as throboangiitis obliterans. Studies have shown Bone Marrow Mononuclear cells may enhance neovascularization in ischaemic limbs secondary to Buerger’s disease. We are describing 2 cases of Buerger’s disease with history of multiple amputations of the toes, treated with stem cell therapy.

CASE 1

25 year old smoker presented with non healing painful foot ulcer for 2 months duration. On examination, there was an ulcer at right fifth toe. Digital Substraction angiography showed a single arterial supply to both lower limb and cork-screw appearance at the ankle region. Wound debridment was done. Autologous bone marrow Mononuclear cells (BM-MNC) obtained using the standard protocol and injected intramuscularly to the calf, plantar and lateral region of the right lower limb. Another cycle of autologous bone marrow mesenchymal stem cells (BM-MSC) injection was done on the subsequent month. There was no immediate or post-procedure complication. Digital substraction angiography 1 month after the therapy showed improvement of collaterals at the affected leg. His ulcer healed at 2 months follow-up.

CASE 2

35 year old man, a smoker presented with wet gangrene of the right fourth and fifth toe. He had history of ray amputation of the right first and third toe, with right femoral-popliteal bypass done 6 months prior to this presentation. Digital Substraction Angiography showed feature of Buerger’s Disease. Right transmetatarsal amputation was done. The wound was noted to be slow healing. 2 cycles of autologous bone marrow injection was done at the calf muscles, plantar and wound. Digital substraction angiography post procedure shows increased collateralizations of the right lower limb and foot. After 2 months, the transmetartasal amputation wound healed, patient was asymptomatic.

CONCLUSION

Our result shows the stem cell therapy can treat ischaemic limb secondary to Buerger’s disease.

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Supplementary Issue