Prostaglandins Therapy in Critical Limb Ischemia: Prospective Study

Introduction: Critical limb ischemia (CLI) is considered the most severe pattern of peripheral vascular disease. It is presents with chronic ischemic rest pain, ulceration or gangrene attributed to peripheral vascular diseases. Prostanoids are prostaglandin analogues which are potent vasodilators and inhibitors of platelet aggregation. In this study, this property has been utilized in treatment of limb ischemia. The aim of this study is to assess the role of prostaglandin in decreasing the amount of pain due to limb ischemia. Materials and Methods: A prospective single arm study with 30 patients underwent prostaglandin therapy for 9 to 12 weeks. 1ml of alprostadil (prostaglandin E1) is diluted in 4ml Normal saline to make it 5ml. 1 ml from the 5 ml is diluted in 500 ml ns and given as infusion for 8 hours for 5 days. 3 such cycles repeated. Pain is assessed using visual analog score before and after infusion. Patients present with claudicating pain with proven peripheral vascular diseases even on Doppler are taken into account. Results: The mean age of the study subjects was 58.13±13.29 years. Majority of 24(80.0%) patients were male and 6(20.0%) were female. The mean VAS score was 8.13 with a standard deviation of 1.04. After the infusion, the mean score significantly decreased to 2.8 with a standard deviation of 1.54. The p-value of <0.0001 indicates that this reduction in pain scores was statistically significant, demonstrating a considerable decrease in pain following the infusion. Conclusion: The study demonstrates that IV infusion of PGE1 is effective in significantly reducing pain associated with limb ischemia. The findings suggest that PGE1 not only alleviates pain but also has potential implications for reducing amputation rates and promoting ulcer healing.