Author(s): ohn Sajan Kurien1, Sansho Elavumkal Ulahannan2, Sandeep Abraham Varghese3, Saravanan Thangavel4, Mubashir Darrussalah5, Toney Jose6, darsh Indra Nath7, Jithesh Purushothamanpillai8
Critical Limb Ischaemia (CLI) was defined for the first time in 1982 by P. R. F. Bell as a manifestation of peripheral artery disease, which describes patient with typical chronic ischaemic rest pain or ischaemic skin ulcers or gangrene.1 This term of CLI should only be used in patients with chronic ischaemic disease defined as presence of recurring rest pain that persists for more than two weeks requiring regular analgesics and with ulceration or gangrene of the foot or toes. These criteria correspond to stage 3 and 4 of Fontaine’s classification of POVD. Observational studies have shown that one year after diagnosis of CLI, 25% of patients experience a major amputation, 25% had died and only 50% survived without requiring a major amputation, though some have rest pain, ulcer or gangrene persisting. The primary goals in treating CLI are to relieve claudication pain and rest pain, to heal the ulcer, to prevent amputation of limbs, to improve quality of life and to prolong survival. The aim of the study is to study the improvement of claudication pain, rest pain and improvement of the level of amputation in patients with diffuse peripheral arterial disease (CLI) after administration of PGE1.
MATERIALS AND METHODS
From June 2013 to November 2014, a total of 45 patients having advanced CLI (Fontaine’s grade III and IV) not suitable for angioplasty and stenting or bypass procedures received different courses of PGE1. 20 patients (44.44%) received 6 full courses of PGE1,3 patients (6.66%) received 5 courses, 5 patients (11.11%) received 4 courses, 4 patients (8.8%) received 3 courses, 4 patients (8.8%) received 2 courses and 9 patients (20%) received one course. PGE1 was administered through intravenous infusion (alprostadil 100mcg) over 10 hours a day for 5 days in one month (1course). The reduction in claudication and rest pain, improvement in level of amputation and complications were assessed.
In all cases, there was reduction in pain scale and Fontaine’s grade irrespective of the courses of PGE1 taken. 14 patients (31.1%) did not require amputation of limbs/toes, 24 patients (53.3%) have the same amputated status, while 7 patients (15.6%) required higher amputation.
PGE1 is an alternative treatment for amputation in patient presenting with advanced CLI and it is effective in reducing the claudication pain, rest pain and improving the level of amputation.