VEGF As A Marker For Improvement In Angiogenesis And Collateral Circulation Post Ilizarov Procedure In Peripheral Arterial Occlusive Disease (Buerger’s Disease) Patients-An Observational Study

Abstract

Introduction Vascular endothelial growth factor (VEGF) is a potent endothelial mitogen. The ability of VEGF to induce the formation of a collateral circulation in ischaemic extremity has been demonstrated. We assessed the patients of peripheral arterial occlusive disease, clinical improvement after Illizaro application and the level of VEGF pre & post Illizaro procedure.

Material and Methods: A total of 10 patients with peripheral arterial occlusive diseases were enrolled. Patients were evaluated in detail clinically, by Color Doppler and CT angiography and their VEGF level were measured pre-operatively and post-operatively at 1 month and 3-month intervals. Routine evaluations were done in all patients.

Results: All the four clinical parameters, i.e. pain score, temperature variation between two limbs, skin changes and ABPI showed significant improvement following treatment (p<0.001). Post-treatment assessment of Color Doppler Flowmetry revealed an increment in flow velocity all three arteries i.e. Anterior tibial artery, Posterior tibial artery and Dorsalis Pedis artery of lower limb which was also found to be significant statistically (p<0.001).

Post contrast enhancement was present in PTA and ATA preoperatively in all patients and in only 6 patients show post contrast enhancement in Dorsalis pedis artery pre-operatively. At 6 months post-operatively dorsalis pedis artery post contrast enhancement increased from 60% to 100% thus showing statistically significant change (p=0.025).  Similar to above data there is significant increase in no of collateral circulation of affected limb(p<0.001). 

Post-operative VEGF level also shows significant increase at 1 month and 3-month interval with significant p value <0.001.

Conclusion: Our study concludes that Combinations of VEGF with other growth factors (such as with angiopoeitin-1, hepatocyte growth factor) can be tested as alternative strategies to promote new vessel growth.