Acute and long-term effects of prostaglandin E(1) assessed by clinical and microcirculatory parameters in critical limb ischemia: A pilot study

We treated 14 patients suffering from critical limb ischemia (CLI) as defined by the Consensus Document, and in whom possibilities of surgical or percutaneous arterial reconstruction were excluded, by PGE(1) 60 mu g i.v. daily during 3 weeks. Effects were evaluated by clinical, macrocirculatory and microcirculatory parameters during a follow-up of 1 year. After treatment with PGE(1), we noted a significant reduction in analgesic use and in pain score. The average tcpO(2) values on the forefoot in the supine and sitting positions, with or without inhalation of Oz through a face mask, showed a significant improvement after 3 weeks, as well as capillary stage. Laser Doppler flux did not change, but was significantly higher in diabetic patients than in nondiabetics with CLI. In 4 patients (28%) no improvement could be found after 3 weeks' treatment. Although in 6 patients the improvement lasted for up to 4 months, the legs eventually deteriorated. In 4 patients (28%) the legs were preserved after 1 year without further active therapy. No patient with initial tcpO(2) values above 40 nun Hg in the supine and 100 mm Hg in the sitting positions during O-2 inhalation lost a leg. Although other effects like local care could have influenced the outcome favorably, we noticed a beneficial albeit transient effect of PGE(1) for the majority of our patients with CLI. TcpO(2) measurements with O-2 inhalation might be a valuable predictor of a positive long-term result.