PERIFERIK ARTERYEL OKLUZIF HASTALIKLARDA PROSTAGLANDİN El İNFÜZYONU

OZET Periferik arteryel okluzif hastaliklarin komplikasyonlarindan biri alt ekstremitenin nekrotik ulserleridir. Ozellikle hastaligin ilerlemis oldugu ve cerrahi rekonstruksiyon yapilamayan hastalarda bu lezyonlarin cesitli tedavilere ragmen iyilesmemesi yasam kalitesini dusuren rahatsiz edici bir durumdur. Prostaglandin El, (PGE1) iskemik lezyon gelisen hastalarda konservatif tedavide kullanilan alternatif bir ilactir. Bu calismada PGEl'in etkinliginin klinik sonuclari incelenmistir. Mersin Universitesi Tip Fakultesi Arastirma ve Uygulama Hastanesi Gogus Kalp Damar Cerrahisi kliniginde Nisan 1999 - Nisan 2000 arasinda iskemik lezyon veya istirahat agrisi yakinmasiyla basvuran hastalardan cerrahi tedavi sansi bulunmayan 4'une intravenoz (IV) PGE1 tedavisi uygulanmistir. Hastalar fizik muayene, alt ekstremite arteryel renkli doppler inceleme ve anjiografi ile degerlendirilmis ve ayak bilegi kol indeksi (ABI) olcumleriyle izlenmistir. Tedaviden once ve tedavi bitiminden 30 gun sonra ayaklarinda lezyonu bulunan hastalarda lezyonlarin fotograflari cekilerek gorsel degerlendirme yapildi. Lezyon bulunan 3 hastamizda lezyonlar tamamen kapandi. Istirahat agrisi olan hastamizda ise agrida hafif bir azalma ancak yurume mesafesinde artma oldugu tespit edildi. Tum hastalarda ABI calisma oncesinde kaydedilen degerlere gore artmis saptandi. Distal okluzif hastalik nedeniyle rekonstruktif cerrahi yapilamayan iskemik lezyonlarda IV PGE1 infuzyonu vazodilatasyon ve cilt mikrosirkulasyonunda artis saglayarak lezyonlarin iyilesmesinde klinik olarak etkin olmaktadir. Anahtar Kelimeler: Prostaglandin El, aterosklerozis, distal okluzyon SUMMARY PROSTAGLANDIN El INFUSION FOR PERIPHERAL OCCLUSIVE DISEASE Necrotic ulceration at lower extremities is one of complications of peripheral arterial occlusive disease. Especially for patients at late stages of disease and not suitable for surgical reconstruction, for the lesions not to improve the lesions in spite of different therapies is a disturbing situation lowering quality of life. PGE1 is one of the alternative medicines used for conservative management of patients with ischemic lesions. Clinical results of PGE1 efficacy is investigated in this study. Intravenous (IV) PGE1 therapy was applied to four patients who had no chance of surgery among the patients who applied to Thoracic and Cardiovascular Surgery Department at the Mersin University Faculty of Medicine Research Hospital between April 1999 and April 2000 with the complaint of ischemic lesions or resting pain. Ali of the patients were evaluated with physical examination, arterial color Doppler investigation of lower extremities and angiography and followed with measurements of ankle-brachial index (ABI). Patients with foot lesions are evaluated visually, taking photos of lesions before and 30 days after the treatment. Ali lesions are totally healed in three patients who had lesions. For the patient with resting pain, slight reduction in pain but increased walking distance were ascertained. ABI was ascertained to have increased according to measured values before study in ali patients. For ischemic lesions for which reconstructive surgery was not possible due to distal occlusive disease which reconstructive surgery might not done, IV PGE1 infusion making vasodilatation and increasing microcirculation at the skin is clinically efficient for healing of the lesions. Keywords: Prostaglandin El, atherosclerosis, distal occlussion