Low-intensity pulse ultrasound (LIPUS) for “no-option” chronic/critical limb-threatening ischemia in a patient with Buerger disease: a case report

Buerger disease, also known as Winiwarter-Buerger disease or thromboangiitis obliterans (TAO), is a non-specific inflammation of small and medium-sized arteries with thrombus obliteration and without atherosclerotic changes. Patients with TAO can develop chronic limb-threatening ischemia (CLTI) and are at risk of limb amputation despite smoking cessation and exercise therapy recommendations. A 72-year-old Japanese man presented with painful discoloration of toes and renal impairment. He was diagnosed with Rutherford-Classification stage 6 CLTI with IgA nephropathy. He refused limb amputation. Clinical symptoms improved after treatment with low-intensity pulsed ultrasound (LIPUS). LIPUS is a noninvasive option to improve peripheral arterial disease symptoms. Despite the conventional therapy measures, there was worsening of the limbs condition. The noninvasive investigational treatment option of LIPUS was initiated after the poor clinical outcomes of the conventional therapy measures. The patient’s symptoms in the bilateral lower limbs, ulcers and the blue-colored toes gradually recovered. After one year of treatment with LIPUS, he had achieved better walking independence with improved quality of life. LIPUS is a noninvasive option for therapeutic angiogenesis with the potential to improve ischemic limb conditions in patients with peripheral arterial disease and to avoid major amputation.