Effectiveness of therapy with iloprost in hand-arm vibration syndrome

To evaluate the efficacy and tolerance of therapy with iloprost in hand-arm vibration syndrome.

We describe a clinical case of a male aged 53 years, who was a heavy smoker for 30 years and a mason working with vibrating tools since 1962. He presented with a history of 10 years of attacks of vasospasm, functional impairment and digital ulceration. He was diagnosed as having hand-arm vibration syndrome vascular stage 4 on the Stockholm Workshop 1986 Scale. Besides suspension from work and abstention from smoking, we began intravenous infusion of iloprost for 6 h in cycles of 3-6 consecutive days, arriving at a dose of 1.5-2.0 ng/kg/min.

After eight cycles, he reported significant symptomatic and functional improvement. Iloprost was seen to be efficacious: the trophic skin lesions disappeared and his microcirculatory perfusion tests improved. There were no significant side effects.

We suggest that the use of iloprost in the treatment of the most advanced stages of vascular hand-arm vibration syndrome warrants further study