Iloprost, Prostaglandin E1, and Papaverine Relax Human Mesenteric Arteries With Similar Potency

Mahlke, Christoph; Kühn, Jens‐Peter; Mensel, Birger; Schreiber, A.; Juretzko, Annett; Steinbach, Antje; Grisk, Olaf

doi:10.1097/shk.0000000000000866

Cited by 11 publications

(6 citation statements)

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“…There has not been any recommendation thus far regarding the type of drugs applied for local arterial treatment. For example, in a recent experimental study by Mahlke et al [ 30 ], iloprost, PGE1 and papaverine dilated pre-constricted human mesenteric arteries by a similar degree in vitro. Iloprost sensitivity was higher in vessels with a small lumen diameter, which is particularly suitable for the treatment for NOMI.…”

Section: Discussionmentioning

confidence: 98%

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Local Intra-arterial Vasodilator Infusion in Non-Occlusive Mesenteric Ischemia Significantly Increases Survival Rate

Winzer

Fedders

Backes

et al. 2020

Cardiovasc Intervent Radiol

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Purpose To investigate the outcome of local intra-arterial papaverine infusion therapy in patients with non-occlusive mesenteric ischemia (NOMI), and factors influencing survival, in comparison with a conservative approach. Methods From 2013 to 2019, patients with NOMI confirmed by imaging were included in a retrospective two-center study. According to different in-house standard procedures, patients were treated in each center either conservatively or interventionally by a standardized local infusion of intra-arterial papaverine into the splanchnic arteries. Thirty-day mortality and factors influencing the outcome, such as different demographics and laboratories, were compared between groups using Kaplan–Meier survival analysis and Cox regression, respectively. Results A total of 66 patients with NOMI were included, with n = 35 treated interventionally (21 males, mean age 67.7 ± 12.3 years) and n = 31 treated conservatively (18 females, mean age 71.6 ± 9.6 years). There was a significant difference in 30-day mortality between the interventional (65.7%; 12/35 survived) and the conservative group (96.8%; 1/31 survived) (hazard ratio 2.44; P = 0.005). Thresholds associated with a worse outcome of interventional therapy are > 7.68 mmol/l for lactate, < 7.31 for pH and < − 4.55 for base excess. Conclusion Local intra-arterial papaverine infusion therapy in patients with NOMI significantly increases survival rate in comparison with conservative treatment. High lactate levels, low pH and high base excess, and high demand for catecholamines are associated with a poor outcome. Level of Evidence Level III.

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Section: Discussionmentioning

confidence: 98%

“…Furthermore, there are promising results using other vasodilators [ 18 , 21 , 24 , 30 ], such as tolazoline, vasopressin, prostacyclins or prostaglandins. There has not been any recommendation thus far regarding the type of drugs applied for local arterial treatment.…”

Section: Discussionmentioning

confidence: 99%

Local Intra-arterial Vasodilator Infusion in Non-Occlusive Mesenteric Ischemia Significantly Increases Survival Rate

Winzer

Fedders

Backes

et al. 2020

Cardiovasc Intervent Radiol

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“…In refractory cases, vasodilator infusion with papaverine, nitroglycerin, and prostaglandins has been described, but experience has been largely anecdotal, and the dose, duration, and selection of drugs have not been standardized. 14 , 15 …”

Section: Discussionmentioning

confidence: 99%

Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass

Magee

Plotkin

Bowser

et al. 2018

Journal of Vascular Surgery Cases, Innovations and Techniques

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Vasospasm immediately after lower extremity arterial bypass may represent an uncommon cause of early graft failure. We report a successful case of catheter-directed, intra-arterial continuous vasodilator infusion to salvage a bypass graft threatened by severe, refractory vasospasm after incomplete response to nicardipine, verapamil, and nitroglycerin boluses. A continuous nitroglycerin infusion was administered for 24 hours, by which time the vasospasm resolved. At 12 months postoperatively, the graft remained patent with normal results of vascular laboratory studies. This report demonstrates that in cases of refractory vasospasm after peripheral bypass, continuous vasodilator infusion can be an effective treatment to prevent early graft failure.

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“…Nach Anfertigung der digitalen Substraktionsserie können über den liegenden Katheter lokal intraarteriell Vasodilatanzien, meist Papaverin, Prostaglandin E1 oder Iloprost, appliziert werden. Die Wirksamkeit aller 3 Substanzen ist vergleichbar mit einem geringen Vorteil für Iloprost in arteriellen Gefäßen mit 150-300 μm Durchmesser [30]. Nach 12-24 h sollten in einer erneuten Angiografie die Katheterlage und der Therapieerfolg evaluiert werden.…”

Section: Initialtherapieunclassified

Mesenteriale Ischämie in der Intensivmedizin

Junginger

Braun²

2021

Intensivmedizin up2date

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Iloprost, Prostaglandin E1, and Papaverine Relax Human Mesenteric Arteries With Similar Potency

Abstract: Iloprost, PGE1, and papaverine have a similar potency to relax mesenteric arteries. Our data suggest that iloprost but not Rock inhibition may be particularly useful to treat ET-1-induced spasms of distal mesenteric arteries.

Cited by 11 publications

References 35 publications

Local Intra-arterial Vasodilator Infusion in Non-Occlusive Mesenteric Ischemia Significantly Increases Survival Rate

Local Intra-arterial Vasodilator Infusion in Non-Occlusive Mesenteric Ischemia Significantly Increases Survival Rate

Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass

Mesenteriale Ischämie in der Intensivmedizin

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