Z Arztl Fortbild Qualitatssich. 1999 Nov; 93(9): 645-9.

[Special aspects of therapy of non-atherosclerotic vascular diseases]

Schellong SM.

Universit�tsklinik Carl-Gustav-Carus, Medizinische Klinik III, Dresden.

The long term course of thromboangiitis obliterans as well as frequency and extent of major or minor limb amputations depend almost exclusively on the smoking behaviour of the patients. Superficial phlebitis accompanying an acute relapse responds well to high-dose aspirin or NSAIDs. Critical limb ischemia is treated by intra-arterial or intravenous prostaglandins (Alprostadil, Iloprost). Lokal measures for finger, toe, or foot gangrene do not differ from comparable sequelae of atherosclerotic vascular disease. Revascularisation procedures (angioplasty, surgery) have a high rate of technical failure and are indicated only in rare atypical situations. Corticosteroids are the therapy of choice for both vasculitides of large muscular arteries, i.e. temporal arteritis (M. Horton) and Takayasu arteritis. Combination therapy is restricted to steroid refractory disease; while this is the exception in temporal arteritis, it occurs in up to 50% of patients with Takayasu arteritis. Critical limb ischemia due to giant cell arteritis may persist even if the inflammatory activity of the disease is well controlled. Revascularisation procedures in Takayasu arteritis may have good results; as with all other therapeutic measures in this disease, they should be provided by specialized centers. Treatment of Raynaud's phenomenon requires patient evaluation for signs or symptoms of an underlying disease, i.e. some kind of connective tissue disease. Strength and frequency of attacks depend on a number of different factors (triggers) which in a given patient may not be completely understood. Exposition prophylaxis for known triggers and vasodilator drugs are the main therapeutic measures in Raynaud's phenomenon. Careful documentation of disease activity provided, non-classical remedies (behavioural psychotherapy, acupuncture) may be attempted.