INTRAVENOUS ILOPROST TREATMENT FOR THE PERIPHERAL ARTERIAL OCCLUSIVE DISEASE

Purpose: Prostacyclin (PGI2) plays a major role in regulating microvascular blood flow, and in inhibition of thrombocyte aggregation and vasodilatation. Iloprost is a stable PGI2 analog with similar pharmacokinetic qualities. We investigated the role of iloprost treatment on healing, pain relief, ulcer healing, limitation of necrosis, and rates of amputation and mortality in Fontaine"s stage III and IV ischaemic peripheral artery disease patients who were not suitable for arterial reconstruction.

Methods: This prospective study was carried out on 44 consecutive adult patients (35 males, 9 females; mean age 67.2 ± 6.9 years) who had Fontaine"s stage III and IV ischaemic peripheral artery disease and who were not suitable for arterial reconstruction. The study was performed at Dokuz Eylul University Department of Cardiovascular Surgery and Alsancak State Hospital Department of Cardiovascular Surgery. First, arterial disease level and its spread level were established through Doppler ultrasonography and angiography of the lower extremities. Then, intravenous (IV) iloprost at a dose of 2 μgr/kg/min was administered over 6 hours. Mean therapy duration was 14.8 days. The iloprost treatment was discontinued on four subjects who had flushing, diarrhea, headache, and hypotension during the treatment.

Results: After a mean 6.2 months follow-up period, it was established that iloprost treatment significantly decreased the need for analgesics, increased the resting pain-free time, ulcer healing, and limitation of the necrotic area, improved walking distance and ankle-brachial index (ABI) (p < 0.001).

Conclusion: Iloprost therapy is effective in patients with severe ischaemic peripheral artery disease who were inoperable and nonresponsive to classical therapy. Iloprost contributes to healing of tropic lesion by regulating microcirculation, relieves the resting pain, and decreases the incidence of amputation and general mortality. (Turkish J Vasc Surg 2005;14(3):21-26).