Effect of prostacyclin analogue iloprost on haemodynamic parameters during femoro-crural reconstruction

A randomised placebo-controlled trial was conducted to investigate the effects of iloprost, a stable prostacyclin analogue, on peripheral resistance, graft blood flow and mean systemic arterial blood pressure (MABP) during femoro-crural arterial bypass. 3000ng of iloprost, infused into the graft, produced an immediate drop in peripheral resistance by a mean (range) of 40% (4-80%) (P less than 0.01, Wilcoxon). Decreased peripheral resistance persisted to 20 minutes. Graft flow during the same period increased by 52% (-7 to 294%) (P less than 0.01). A transient maximal drop in mean MABP of 22% from 83-65 mmHg occurred 5 minutes post iloprost infusion but caused no detrimental effects and recovered to baseline values by 10 mins. Iloprost produces an immediate decrease in peripheral resistance associated with a prolonged increase in graft blood flow. This may reduce graft failure in the early postoperative period.