Outcomes of Alprostadil As an Adjuvant Therapy with Indirect Angiosomal Revascularization in Patients with Critical Limb Ischemia after Failure of Direct Revascularization

• Published in: Annals of vascular surgery Vol. 103; pp. 58 - 67
• Main Authors: Alhewy, Mohammed Alsagheer, Abdo, Ehab M., Ghazala, Ehab Abd Elmoneim, Khamis, Ahmed Atef, Gado, Hassan, Abd-Elgawad, Wael Abdo Abdo, Abdelhafez, Abdelaziz Ahmed, El Sayed, Abdullah, Khedr, Alhussein M., Mosaed, Haytham Ameer Mahmoud
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.06.2024
• ISSN: 0890-5096; 1615-5947; 1615-5947
• DOI: 10.1016/j.avsg.2023.12.078

This study was carried out to assess the effectiveness of alprostadil (prostaglandin E1) when used as an adjuvant therapy with indirect revascularization in patients with critical limb ischemia (CLI) after the failure of direct revascularization (DR). At our centers, 120 patients suffering from infrainguinal peripheral arterial disease with CLI underwent a failed trial of DR procedure, all revascularization procedures were endovascular. Median follow-up was 2 years and 2.5 years for patients with and without diabetes mellitus (DM). In the alprostadil group, the mean age was 63.41 ± 12.52; 36 (60%) for males and 24 (40%) for females. Post-endovascular intervention alprostadil was administrated immediately postoperatively by intravenous infusion of 40 μg alprostadil diluted in 100 ml of normal saline, over 2 hr every 12 hr for 6 days. In the alprostadil group, the mean ± standard deviation (SD) of the baseline ankle-brachial index (ABI) was 0.45 ± 0.175, while the mean ± SD of ABI at the end of our study was 0.65 ± 0.216 with a difference from the baseline of 0.2 ± 0.041 (P value = 0.08, <0.05 meaning that it is significant). Our 1-month primary patency rate was 93.3%, while our 3- and 6-month patency rate was 92.9%. In the control group, the mean ± SD of the baseline ABI was 0.68 ± 0.22, while the mean ± SD of ABI at the end of our study was 0.69 ± 0.23 with a difference from the baseline of 0.01 ± 0.01 (P value >0.05 meaning that it is nonsignificant) 1-month patency rate was 89%, while 3- and 6-month patency rate was 75%. When we compared the patient's leg vessels before and after our intervention, we found that the percentage of the no-runoff-vessels group decreased from 10 (16.7%) to 4 (6.67%). One-runoff-vessel group percentage dropped from 40 (66.7%) to 36 (60%), whereas, in the two-runoff-vessel group, the percentage increased from 10 (16.7%) to 20 (33.3%). We evaluate leg arteries; we do no pedal arch intervention in the alpostradil group. Out of the total of 60 patients, limb salvage occurred in 58 (96.7%) patients, and 2 (3.3%) patients underwent below-the-knee amputation before the study ended. Our results show the efficacy and safety of alprostadil as an adjuvant therapy with indirect angiosomal revascularization in patients with tissue loss due to CLI. •Peripheral arterial diseases affect up to 20% of the elderly worldwide.•Early intervention is the gold standard in reducing the possibility of amputation. Angiosome: tissue region supplied and drained by specific vessels.•IR with prostanoids improves outcomes when DR is not applicable.•Alprostadil enhanced ulcer healing, and pain relief in ischemic limbs.•Alprostadil improved the proportion of survival without major amputation.