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[Pharmacological treatment of chronic arterial occlusive disease (author's transl)]
Insights
Conservative treatment for peripheral arterial occlusive disease shows promise. Energetic phosphates and Ancrod (a defibrination enzyme) offer effective pharmacological options for improving circulation and patient outcomes.
Area of Science:
- Vascular Medicine
- Pharmacology
- Biochemistry
Context:
- Peripheral arterial occlusive disease (PAOD) affects a significant patient population, with many requiring conservative management.
- Operative revascularization is only feasible for a minority of PAOD patients.
- Conservative treatment strategies must consider disease severity and localization.
Purpose:
- To evaluate the efficacy of intrafemoral energetic phosphates and defibrination with Ancrod as conservative treatments for PAOD.
- To compare the outcomes of these pharmacological interventions based on disease severity (Fontaine classification) and localization.
- To analyze hemodynamic and metabolic parameters in response to treatment.
Summary:
- Intrafemoral energetic phosphates (nucleotide-nucleoside mixtures) achieved positive results in nearly two-thirds of patients (n=97) with Fontaine stages II-IV PAOD, particularly in Fontaine stage II with intermittent claudication.
- Ancrod, a snake venom enzyme causing defibrination, was successful in almost 70% of patients (n=45) with arterial insufficiency, including those with severe symptoms (Fontaine IIB, <100m walking distance).
- Ancrod demonstrated particular efficacy in patients experiencing rest pain, suggesting its utility in more advanced stages of arterial insufficiency.
Impact:
- These findings support the use of targeted pharmacological interventions as effective conservative treatments for PAOD.
- The study provides evidence for differential application of energetic phosphates and Ancrod based on clinical presentation and disease severity.
- Hemodynamic and metabolic assessments offer insights into the mechanisms of action and treatment response in PAOD management.
Abstract:
Two thirds of the patients with peripheral arterial occlusive disease have to be treated conservatively, for only up to 30% can be revascularized by operative methods. Using the pharmacological differential treatment the grade of compensation and localization of the obliterative process has to be considered. Ignoring the usual basic therapy (elimination of heart failure and pathological bradycardia, systemic walking-exercise, anticoagulation etc.) intrafemoral long-term application of energetic phosphate (i.e. nucleotid-nucleosid-mixtures) leads to a positive result in nearly two thirds (n = 97 legs) with a degree of II to IV of Fontaine. Whereas the snakes' encyme Ancrod with the effect of defibrination was successful in almost 70% of the patients with arterial insufficiency (n = 45) including the degree II B (painless walking-distance under 100 meters). Energetic phosphates, applied to the arteria femoralis, are most successful in degree II with claudication intermittens. Ancrod should be used respectively for patients with pain during rest. These results are discussed with respect to compensation and localization of arterial occlusive disease, acute and chronic measurements of the hemodynamics by use of Doppler ultrasound and strain gauge plethysmography and with respect to variation of the concentration of the metabolic parameters lactate and pyruvate--the latter when defibrination was performed.