Regression of Thromboangiitis Obliterans Induced Finger and Toe Ischemia with Medical Cannabis Therapy

The current case report describes regression of digital ischemia in thromboangiitis obliterans patient following high-dose medical cannabis therapy (MCT). MCT therapy was instituted as a pain-mitigating treatment when the patient refused amputation due to ischemic and infected foot. Three years later the digital ischemia has resolved leaving minimal scarring. The mechanism of action might be related to the anti-tobacco use effects of MCT as well as the anti-inflammatory action of CBD. The endocannabinoid system is important in vascular system function via the CB-1 and CB-2 receptors that are widely distributed in the vascular system(1). The relationship between cannabis usage and vascular problems has not been fully elucidated. The current state of knowledge does not support a statistical association between increased incidence of myocardial infarction and cannabis use(2). Some authors have found that cannabis use is associated with cardiovascular problems and there is a 3.5 odds ratio of being a cannabis user in patients with thromboangiitis obliterans(3). However, this might not be causative but rather an attempt at therapy by the patients. In fact, a mechanism of action by activation of CB-2 receptors is likely to mitigate atherosclerosis. The possible mechanism involves CB2 receptors playing an important compensatory role in controlling tissue inflammation and injury in infiltrating monocytes/macrophages and leukocytes during various pathological conditions of the systems such as atherosclerosis and restenosis(4) These receptors limit inflammation and associated tissue injury. The current case report describes the use of high-dose cannabis (Medical Cannabis Therapy, MCT) as a therapy for severe thromboangiitis obliterans and results three years later