Intravenous infusion of prostaglandin E1 in ischemic ulcer and rest pain for extremities due to peripheral vascular disease

Abstract

Prostaglandins are potent vasoactive agents with wide variety of other actions - vasodilatation, fibrinolysis and inhibition of platelet aggregation. PGE1 was the agent used since 1973 for cardiovascular diseases, mainly in patients with advanced PVD. PGE1 intra venous infusion has shown to be beneficial in limb threatening ischemia, especially when reconstructive procedures are not feasible. The original research of benefitted 35 cases in last 5 years is presented here. Background: As a General surgeon we use only analgesics and anti-platelet agent aspirin for severe ischaemic limbs with rest pain. We could not improve patient’s quality of life with these medications. Enough of medicine literature says prostaglandins E1 improves microcirculation, stop tissue damage due to ischemia and relief from rest pain. Methods: In this study we included both gender patients above age of 34 years who had ischemic changes associated with peripheral vascular disease and rest pain. We infused intravenous prostaglandins E1 and studied them for improvement in soft tissue ischemic changes and in rest pain. Results: clinical success was evaluated according subjective grading and relief of pain. Patients in these studies had a pain score from 6 onwards as per Wong-Baker FACES pain rating scale improved to 2-4. We also studied them for Fontain and Rutherford staging and scoring system, which improved from III b to II-I and from 4 to 2-1 respectively. Conclusions: Intravenous infusion of PGE1 alprostadil on 5 days a cycle basis, in selected patients with severe rest pain and ischemia seems to be very effective, without any serious complications.