Contribution of prostaglandin E1 treatment in patients with critical limb ischemia

Background and aims: Peripheral arterial disease (PAD) in advanced stages has severe disabling complications. Major amputations (MA) and high mortality rates are common in patients with critical limb ischemia (CLI). Revascularization (interventional angioplasty or vascular surgery) appears to be possible in the large majority of cases if these patients are referred to a specialist earlier. Patients with CLI and lacking options for revascularization have worse prognosis. The purpose of this retrospective study was to investigate the impact of including prostaglandins in the treatment of patients with CLI lacking the possibility of revascularization. Method: This retrospective study cohort includes 67 patients (34 male and 33 female), mean age 71 +/- 10.7 years treated for CLI not suitable for revascularization. Prostaglandin E1 (alprostadil) was applied by intravenous perfusion with doses of 40 mu g twice a day for 2 weeks. Results: 23 patients (34.3%) underwent amputation and 17 patients (40.3%) died during the total follow-up period (01/2009-07/2014). Mortality rate was higher in patients who have undergone an amputation, in diabetics and in patients without statin medication. Conclusion: Patients with CLI lacking options for revascularization have despite treatment with prostanoids (alprostadil) a poor prognosis, with high amputation rate and increased mortality. Statin medication was a protective factor for survival.