An amputation alternative for patients with Critical Limb Ischemia

Abstract

After the Prostaglandin E₁ (PGE₁) application, vasoactive therapy became an alternative to arterial surgery. The purpose of this study is to justify the PGE₁ treatment in hopeless cases with Critical Limb Ischemia (CLI). The analysis presented covers 7 years experience with PGE₁ therapy applied on 103 CLI cases. The patients were divided into 2 groups: 29 with post-operative deterioration and 74 non-operable cases with atherosclerosis, TAO or diabetes. PGE₁ was applied by intravenous or intraarterial infusions, 10 days for non-responders and 4–6 weeks for responders. Patients were followed from 6 months to 7 years, mean 33 months. Satisfactory results were recorded for 9 operated patients. In the group of non-operable patients the effect was better and good results were documented in 39 cases. The limbs of 48 patients who responded to the therapy were saved and almost all became claudicants later on. In 49 (89%) of non-responders high amputations were performed. Nine cardiac deaths were observed. Side-effects were registered in 6 cases (5,8%). PGE₁ treatment is an amputation alternative in 46,6% of patients with CLI, 31% after ineffective surgery and 52,7% for non-operable patients. The best results were observed for TAO-patients. Side effects were insignificant.