Efficacy of prostanoids in patients with critical leg ischemia

Brodszky, Valentin; Farkas, Katalin; Járai, Zoltán; Anna, Landi; Pécsvárady, Zsolt; Baji, Petra; Balogh, Orsolya; Gulàcsi, László; Péntek, Márta

doi:10.1556/oh.2011.29277

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…Prostanoids (alprostadil and iloprost) are used for the treatment of patients with critical limb ischemia in whom revascularization procedure was inadequate or proved to be unsuccessful. Brodszky et al reported that alprostadil had favorable effects of rest-pain relief and ulcer healing in critical limb ischemia 19. Besides, a recent study reported that sildenafil (50 mg q 12 hour) was effective in severe peripheral ischemia induced by terlipressin, and that the wound also improved in two weeks 13.…”

Section: Discussionmentioning

confidence: 99%

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

Lee

2013

Clin Mol Hepatol

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Variceal bleeding and hepatorenal syndrome (HRS) are serious and life-threatening complications of advanced liver disease. Terlipressin is widely used to manage both acute variceal bleeding and HRS due to its potency and long duration of action. The most severe (though rare) adverse event is ischemia. The present report describes the case of a patient with gangrene and osteomyelitis secondary to terlipressin therapy. A 71-year-old male with alcoholic liver cirrhosis (Child-Pugh B) and chronic hepatitis C was admitted due to a drowsy mental status. The patient had several experiences of orthopedic surgery. His creatinine level had gradually elevated to 4.02 mg/dL, and his urine output decreased to 500 mL/24 hr. The patient was diagnosed as having grade III hepatic encephalopathy (HE) and type II HRS. Terlipressin and albumin were administered intravenously to treat the HRS over 11 days. Although he recovered from the HE and HRS, the patient developed peripheral gangrene and osteomyelitis in both feet. His right toes were cured with the aid of rescue therapy, but his left three toes had to be amputated. Peripheral gangrene and osteomyelitis secondary to terlipressin therapy occur only rarely, and there is no specific rescue therapy for these conditions. Thus, attention should be paid to the possibility of ischemia of the skin and bone during or after terlipressin therapy.

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Section: Discussionmentioning

confidence: 99%

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

Lee

2013

Clin Mol Hepatol

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“…Brodszky et al demonstrated the favourable effect of prostanoids on rest pain relief and ulcer healing in patients affected by critical lower limb ischemia, analysing seven randomised controlled trials including 964 patients. Ruffolo et al analysed data collected from the Cochrane Central Register of Controlled Trials and concluded that further well‐conducted, high‐quality randomised double‐blinded trials should be performed to give definitive data on the long‐term effectiveness and safety of different prostanoids in patients with critical lower limb ischemia.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of prostaglandin E1 in patients with mixed arterial and venous ulcers of the lower limbs

Caridi

Massara

Stilo

et al. 2014

International Wound Journal

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Mixed arterial and venous ulcers of the lower limbs are present in around 15-30% of patients with chronic venous ulcers (CVUs) and are considered difficult-to-heal wounds. The aim of this study was to evaluate the results of the treatment of mixed arterial and venous ulcers of the lower limbs with prostaglandin E1 (PGE1) infusion. This study was carried out in 48 consecutive patients. Patients who showed intolerability to PGE1, and patients with peripheral neuropathy, blood or systemic diseases, malignancy and acute wound infections or necrotic tissue on the wound bed were excluded. The patients were separated at random into two main groups: group I (25 patients) received standard treatment and PGE1 infusion. Group II (23 patients) received only standard treatment. Pre-treatment data indicated the area of ulceration. The number of healed ulcers and the variation in the area of ulceration were considered as endpoints. The endpoints were noticed after 120 days from the beginning of treatment. Healing occurred in 80% of limbs of group I and in 52·2% of limbs of group II patients. The average reduction in area was 92% versus 60% in patients of group I and II, respectively. During the whole treatment period, the incidence of adverse events was 8% in group I: there was one case of headache and one case of headache and hypotension combined. No side effects were recorded in patients of group II. In conclusion, PGE1 infusion is a determinant in the reduction of the healing time of mixed ulcers of the lower limbs.

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“…These include alprostadil (PGE1 analogue) [9], sildenafil [10] and nitrates [11] as reported by various authors. Nevertheless, amputation remains the last resort in limb gangrene.…”

Section: Referencesmentioning

confidence: 99%