TREATMENT AND OVERALL OUTCOME OF ARTERIAL OCCLUSIVE DISEASE
- PART II
D. Kočo, M. Dilić, S. Pehar and E. Kurtalić.
of Vascular Diseases, Clinical Center University of Sarajevo,
Bosnia and Herzegovina
Alprostadil is substance from a group of prostacyclines, recently
has been used in a treatment of arterial occlusive disease (AOD)
i.e. atherosclerosis obliterans, thromboangiitis obliterans, diabetic
angiopathy. Aim: (i) to evaluate results of treatment with alprostadil
on several clinical parameters: value of claudication distance
(CD), Doppler-pressures (DP), brachiopedal index (BPI), pletismography
and local status, (ii) to compare results with the first part
of study by formal meta-analysis, on an intention-to-treat basis.
Methods: in the first part of study (patients treated on Institute
in a period from June 1996 to April 1998) 17 patients were treated:
in 7 patients an improvement was achieved, 5 pts. Were without
significant changes, 5 patients were with worse clinical status.
Second part of study, (a period from May 1998 to April 2001),
evaluate 20 patients with arterial occlusive disease (AOD). From
a total of 20 patients, 10 (50%) were with obliterating atherosclerotic
changes, 7 patients (35%) were with diabetic angiopathy and 3
(15%) pts. were with thromboangiitis obliterans. According to
Fontaine classification (staging) of arteriopathies, on the beginning
of treatment 12 pts. (60%) were in stage IV, 2 pts. (10%) were
in stage III, and 6 pts. (30%) were in stage II. At the end of
infusion period, patients were classified as responders or non-responders
on the basis of pain relief in the stage III, or signs of ulcer
healing in the stage IV. By evaluation of parameters: CD, DP,
BPI, pletismography and local status on the end of treatment -
10 pts. (50%) were presented with improved status, 7 pts. (35%)
were without changes and worse status was noticed in 3 pts. (15%).
We had not any serious interactions
Conclusions: based on results of both part of the study we conclude
that alprostadil is an effective substance, especially in patients
with stage IV, that cannot undergo reconstructive vascular surgery
due to different reasons. On the other hand, these results represent
end of the infusion period, and real clinical efficacy needs to
be judged in the longer term on the basis of harder end-points.