TREATMENT OF CRITICAL LIMB ISCHAEMIA WITH PROSTAGLANDINS
Critical limb ischaemia is defined as ischaemic rest pain for 2 weeks or necrosis/gangrene of a toe, foot or ankle, corresponding to stages III-IV according to Fontaine classification of peripheral vascular disease. The aim of this paper is to evaluate the efficacy of PGE1 administred as an intravenous infusion in diabetic patients with critical limb ischaemia. There were selected to receive PGE1 16 diabetic patients (7 men and 9 women) with critical limb ischaemia. Stage III peripheral arterial disease was identified in 10 patients (62.5%) and stage IV in 6 patients (37.5%). None of the patients was a proper candidate for reconstructive surgery (arterial stenting or bypass). PGE1 was administred by slow intravenous infusion of 2 ampoules (40 micrograms PGE1) in 250 ml isotonic saline solution twice daily for 20 consecutive days combined with conservative treatment. After 3 weeks of treatment all 10 patients with peripheral vascular disease stage III reported pain relief or even disappearance of rest pain. Ulcers healed completely in 3 (50%) patients with stage IV peripheral vascular disease, while the other 3 (50%) patients underwent below-knee (trans-tibial) amputations. PGE1 treatment was effective in diabetic patients with major amputations avoided in all 6 patients with stage IV peripheral vascular disease. Intravenous treatment with prostaglandin E1 resulted in amputation level decrease, ulcer healing, improvements in rest-pain, pain-free walking distance and quality of life.