Related Experiment Videos
[Use of PGE1 in severe ischemia of the lower extremities. Clinical study]
S Occhionorelli1, F Mascoli, G Vasquez
1Istituto di Clinica Chirurgica, Università degli Studi di Ferrara.
Insights
Prostaglandin E1 (PGE1) therapy improved outcomes for patients with critical limb ischemia due to obstructive arterial disease. Many patients avoided amputation, showing reduced disease severity after treatment.
Area of Science:
- Vascular Medicine
- Pharmacology
Context:
- Critical limb ischemia (CLI) is a severe manifestation of chronic obstructive arterial disease (COAD), often leading to amputation.
- Patients with Fontaine's IIIb-IV degree CLI present with rest pain and distal ulcers, indicating advanced disease.
Purpose:
- To evaluate the efficacy of prostaglandin E1 (PGE1) in treating patients with CLI (Fontaine's IIIb-IV) who were candidates for amputation.
Summary:
- Fifty patients with CLI received PGE1 (40 mg bid IV for 20 days). Follow-up included transcutaneous oxygen pressure, Doppler perfusion, pulse, and blood pressure.
- Within two months, 18 patients improved to Fontaine's II degree, and 25 experienced severe claudication (18 underwent successful surgery, 7 had amputations). PGE1 did not benefit 7 patients.
- Reported side effects included headache (4%), erythema/pain at injection site (8%), and nausea (4%), all transient and not requiring therapy cessation.
Impact:
- PGE1 therapy demonstrated potential in limb salvage for select CLI patients, reducing the need for amputation.
- The study highlights PGE1 as a viable treatment option, potentially altering the natural course of advanced obstructive arterial disease.
- Further research may explore optimal patient selection and combination therapies to maximize limb salvage rates in CLI.
Abstract:
Lower limb critical ischemia is a clinical condition typical of patients with severe chronic obstructive arterial disease (Fontaine's IIIb and IV degree). This condition often leads to amputation of the limb involved. The authors present to the use PGE1 in 50 patients with Fontaine's IIIb-IV degree chronic obstructive arterial disease of lower limbs in which the indication of amputation was done. All the patients, admitted to the emergency ward, complain of rest pain and distal ulcers. The administration of PG5(1) was given as follows: 40 mg/bid/e.v./20 days. A 6 months long follow-up was installed with the instrumental evaluation of: Transcutaneous oxygen pressure; Distal blood perfusion with Doppler; cardiac pulse; blood pressure. Eighteen patients became to a Fontaine's II degree during the next 2 months after therapy, 25 patients came back to a severe claudicatio: of them 18 underwent successfully vascular surgery, 7 underwent amputation of the lower limb. In 7 patients the PGE1 did not influence the natural progression of the disease. Among the side-effects of therapy we can mention: headache (4%), erythema and pain of injected vein (8%), sick (4%). All the side effects were transient and never led to interruption of therapy.