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Rivista di Chirurgia Vascolare ed Endovascolare

Official Journal of the Italian Society of Vascular and Endovascular Surgery
Indexed/Abstracted in: EMBASE, Scopus

Periodicità: Trimestrale

ISSN 1824-4777

Online ISSN 1827-1847


Italian Journal of Vascular and Endovascular Surgery 2004 Giugno;11(2):93-9


Iloprost as an adjuvant to surgical revascularization in acute ischemia of lower limbs

De Donato G. 1, Gussoni G. 2, De Laurentiis R. 3, De Donato M. 1, Esposito M. 1, Montemarano E. 1, De Donato G. 1

1 Vascular Surgery Unit “San Giovanni Bosco” Hospital, ASL 1 Second University of Naples, Naples, Italy
2 Scientific Department, Italfarmaco SpA, Milan, Italy
3 Pharmaceutical Service, ASL, Naples, Italy

Acute low­er ­limb ische­mia, ­because it may be not ­only ­limb- but ­even ­life-threat­en­ing, is a seri­ous med­i­cal emer­gen­cy asso­ciat­ed ­with a ­high ­rate of com­pli­ca­tions ­that can ­often devel­op ­despite ear­ly suc­cess­ful treat­ment. In gen­er­al, the imme­di­ate suc­cess ­rates of sur­gi­cal/endo­vas­cu­lar/throm­bo­lyt­ic pro­ce­dures are report­ed­ly ­very ­high, but the ­data ­from the lit­er­a­ture are not ­always ­easy to inter­pret due to the diver­sity of treat­ment strat­e­gies. Acute, ­limb-threat­en­ing ische­mia ­remains bur­dened by sig­nif­i­cant mor­bid­ity and mor­tal­ity ­because of under­ly­ing dis­eas­es and the meta­bol­ic derange­ment ­from ­acute ­insult and pos­sible ­severe reper­fu­sion inju­ry fol­low­ing suc­cess­ful revas­cu­lar­iza­tion. In ­patients under­go­ing Fogarty cath­e­ter throm­boem­bo­lec­to­my, 30-day ampu­ta­tion ­rates of 12-35% and mor­tal­ity ­rates of 13-25% ­have ­been esti­mat­ed, ­while for long­er fol­low-up (6-24 ­months) the inci­dence of ampu­ta­tion and mor­tal­ity is report­ed as 13-24% and 12-52%, respec­tive­ly. Other ­series ­showed 6- and 12-­month ­major com­pli­ca­tions ­rates (limb ­loss and mor­tal­ity) of 20-35% in ­patients ­with ­acute ­limb ische­mia under­go­ing sur­gi­cal revas­cu­lar­iza­tion. Prostanoids are ­drugs con­ven­tion­al­ly uti­lized in crit­i­cal ­limb ische­mia. Iloprost is a syn­thet­ic pros­tac­y­clin ana­logue ­with effec­tive vaso­di­la­tor, anti­plate­let and anti­neu­troph­il prop­er­ties; it has cytop­ro­tec­tive ­effects sim­i­lar to pros­tac­y­clin and reduc­es reper­fu­sion inju­ry ­after pro­longed ischae­mia. Some ­authors ­have report­ed pos­i­tive ­effects of the per­i­op­er­a­tive use of ilo­prost dur­ing femor­o­dis­tal arte­ri­al recon­struc­tion for crit­i­cal leg ische­mia; the ­drug has ­also ­been suc­cess­ful­ly ­used in ­some ­patients ­with ­acute arte­ri­al ische­mia. The ­effect of ilo­prost has ­been eval­u­at­ed in a dou­ble-­blind, pla­ce­bo-con­trolled ­pilot ­study in 30 patients who underwent Fogarty catheter thromboembolectomy for acute thromboembolic occlusion of the lower limbs. The ­drug was admin­is­tered ­intra-arte­ri­al­ly imme­di­ate­ly ­after revas­cu­lar­iza­tion, ­plus by intra­ve­nous infu­sion at con­ven­tion­al dos­es for the fol­low­ing 3 ­days. On the basis of the encour­ag­ing ­results of ­this ­study (low­er inci­dence of ­major ampu­ta­tions, ­more evi­dent meta­bol­ic improve­ment as meas­ured by trans­cu­ta­ne­ous oxy­gen and car­bon diox­ide pres­sure in the ilo­prost-treat­ed ­group), a larg­er, mul­ti­cen­tre ­phase III ­study is ­being con­duct­ed to fur­ther ver­i­fy ­these ­results. Unlike the ­pilot ­study, ­this ­trial ­include ­patients under­go­ing dif­fer­ent ­types of sur­gi­cal revas­cu­lar­iza­tion and a long­er peri­od of intra­ve­nous infu­sion (4-7 ­days). The ­results ­from the ­study are expect­ed in 2004.

lingua: Inglese


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