Vaskulárna medicína 2/2015

Treatment of critical limb ischemia with prostaglandin E1

Peripheral arterial obliterative disease in advanced stages with critical limb ischemia (CLI) is a major disabling complication with frequent need of amputations. The poor and slow wound healing is often aggravated by the frequent comorbidity of foot ulcers with diabetes mellitus. The purpose of this retrospective study was to investigate the impact of prostaglandins in the treatment of patients with CLI and without possibility of revascularization. The study group consisted of 67 patients (34 male and 33 female), mean age 71 ± 10.7 years, diabetes mellitus was present in 37 subjects (55.2 %). Prostaglandin E1 (alprostadil) was applied with doses of 40 μg bid over 2 hours for 2 weeks. During the total follow-up period of 5.5 years (I/2009 – VII/2014) 23 patients (34.3 %) underwent amputation (17 minor and 6 high). There were 27 deaths (40.3 %), mortality was higher in diabetics, in patients who have undergone an amputation and in patients without statin medication. Patients with CLI and lacking options for revascularization have despite treatment with prostaglandin E1 (alprostadil) a poor prognosis, with high amputation and mortality rates. Our results indicate, that although in the medium-term prognosis, treatment with prostaglandin E1 is reducing the need for amputations, the overall high mortality is not favourably affected by this treatment.

Keywords: critical limb ischemia (CLI), prostaglandin treatment, alprostadil, amputations, prognosis.