Experiences with PGE1 in Patients with Phlegmasia Coerulea Dolens and in Ergotism
The use of prostaglandin E1 (PGE1) was investigated in eight patients who were all emergencies, in that their life and limb were in peril. Four patients had phlegmasia coerulea dolens with, despite thrombectomy and fasciotomy, rapidly advancing venous gangrene. Three lower limbs and one upper limb were involved. Continuous, high-dosed, intra-arterial PGE1 treatment saved the three lower limbs. The fate of the upper limb was still in the balance when the patient died of a fulminating pulmonary embolism. Four patients were suffering from ergotism in the wake of multiple trauma and long-term thrombosis prophylaxis with a combined dihydroergotamine-heparin preparation. All the patients were referred to our hospital at a late stage and after many other types of treatment had been tried. Here again, three lower limbs and one upper limb were involved. The combined regimen of continuous intra-arterial and intermittent intravenous PGE1 retained the function of one lower limb and one upper limb. Knee exarticulation in one young woman and below-knee amputation in another young woman were unavoidable. The treatments lasted between 8 and 12 days. The intra-arterial dosage was 0.25 ng/kg · min and the intravenous dosage was 320 µg/day.
KeywordsCatheter Prostaglandin Alkaloid Dextran PGE1
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