Prostaglandin E₁ in critical limb ischemia transcutaneous PO₂: A predictor of efficacy?

Abstract

Prostaglandin E₁ (PGE₁) has found a widespread use in treating patients with critical limb ischemia. Because therapy with PGE₁ is time and cost intensive, a parameter for identifying nonresponders and consecutive therapy failures would be helpful. Therefore, the aim of this study was to evaluate the role of transcutaneous PO₂ (tcPO₂), before and after IV application of PGE₁, in patients with critical limb ischemia as a predictor of efficacy.

Twenty patients with arterial occlusive disease stage IV according to Fontaine and a tcPO₂ of less than 30 mmHg (dorsum of the foot) received one IV infusion of 40 μg PGE₁ in 125 mL saline over thirty minutes. In 11 patients tcPO₂ increased by more than 5 mmHg. These patients were classified as responders. Two patients revealing only a small increase in tcPO₂, 5 patients with unchanged tcPO₂, and 2 patients who showed a decrease in tcPO₂ were considered as nonresponders. Only 2 patients among the responders had baseline tcPO₂ values below 5 mmHg, whereas 6 of the nonresponders showed such low values. Three of the responder group had to undergo an operation in comparison to 6 of the nonresponders.

The increase in tcPO₂ induced by IV infusion of PGE₁ may have predictive value for the effectiveness of conservative treatment. Further validation is necessary.