Prostaglandin E₁ in Arterial Occlusive Disease in Stages III and IV According to Fontaine

Summary

The walking distance, type of pain and ulcer healing were constantly monitored in 25 patients who were not suitable candidates for vascular surgery. Pyruvate, lactate, citrate, oxoglutarate, β-hydroxybutyrate, acetoacetate, proteolytic activity, protease-binding capacity, elastase, cathepsin B, α₁-antitrypsin, α₂-macro-globulin, inorganic phosphates, ATIII, plasminogen, antiplasminogen and factor XIII were monitored for 10 days and there was found to be an objective metabolic correlation. The patients were given daily one dose of prostaglandin E₁ of on average 0.3–0.6 ng/kg body weight · min by intra-arterial infusion lasting 10 hours. Individual dose-response curves were plotted by means of an impedance device. Twenty patients treated with naftidrofuryl served as the control group. With the aid of the impedance measurements and clinical chemistry parameters, the responders could be clearly distinguished from non-responders. In the responders the blood flow increased by 33%, α₁-antitrypsin rose from 108 ± 36% to 156 ± 19%, α₂-macroglobulin remained constant, elastase fell from 144 ± 73 to 111 ± 46 ng/ml. The concentrations of organic acids in venous blood also tended to fall. AT Ill-uptake showed a modest decline from 86 ± 14% to 73 + 12%.

In the non-responders and in patients who only showed a modest response to therapeutic infusions, α₁-antitrypsin and the organic elastase acid concentration rose appreciably.

The results indicate appreciable differences between the metabolic picture in stage III and stage IV; consequently, different reconstructive and conservative therapies are called for. Even an apparently hopeless situation can be surmounted by the conservative approach. It is sufficient if the optimum dose of PGE₁ is gauged and stipulated. The least response to a PGE₁ infusion would still limit the extent of amputation.