Pentoxifylline and critical leg ischemia

The annual incidence of critical leg ischemia has been estimated at 500-1,000 patients per million population/year. In critical ischemia there is a breakdown in the microvascular flow-regulating system and inappropriate activation of the microvascular defense system, with resultant endothelial damage and activation of platelets and leukocytes, which leads to further damage of the capillary network. The mainstay of treatment until recently has consisted of interventional procedures. However, these are not always feasible and are not without significant mortality and morbidity. Therefore, attention has been directed towards pharmacologic management. Pentoxifylline inhibits leukocyte aggregation and activation, and improves red cell deformability and oxygen release to tissue. On the basis of these properties, several pilot studies were undertaken, and most have confirmed the benefits of pentoxifylline in the management of critical ischemia. These positive results led to the initiation of a multicenter, double-blind, placebo-controlled study of intravenous pentoxifylline in the acute management of critical ischemia. Results showed a significant reduction in rest pain with pentoxifylline, and outcome was not influenced by various prognostic factors. Research to date suggests that pentoxifylline could have a definite role in the management of patients with critical ischemia.