Intraindividual evaluation of the optimal PGE1 application route in critical limb ischemia

Abstract

Since prostaglandin E1 was first used for the treatment of critical limb ischemia, the best route of administration—intraarterial (i.a.) or intravenous (i.v.)—has not yet been determined. The aim of this study was to compare the effects of i.a. and i.v. prostaglandin E1 (PGE1) infusions on transcutaneous partial pressure of oxygen (tcPO2) on a within-patient basis in patients with critical limb ischemia. In a randomized, crossover study, 20 patients with critical limb ischemia were treated with a 30-minute i.a. infusion of 10 µg PGE1 in 25 ml saline and a 60-minute i.v. infusion of 40 µg PGE1 in 125 ml saline. During i.a. infusion of PGE1, the mean tcPO2 (forefoot) decreased significantly from 12.2 mmHg to 3.3 mmHg (−73%,p<0.001). In contrast, during i.v. infusion of PGE1, tcPO2 (forefoot) increased significantly from 8.9 mmHg to 16.3 mmHg (+83.1%,p<0.001). Administration by both routes also increased tcPO2 measured at the forefoot of the contralateral limb. These results demonstrate that i.v. administration of PGE1 in contrast to the i.a. route significantly improves oxygen supply to the skin, and therefore should be considered superior to i.a. administration.