Prolonged infusion of prostacyclin in patients with advanced stages of peripheral vascular disease: A placebo-controlled cross-over study

Summary Twelve patients (age 33–77 years, mean age 68.4 years) with peripheral vascular disease (PVD) stage III–IV received continuous intravenous infusions of 5 ng prostacyclin (PGI₂)/kg/min and physiological saline for 7 days. The administration was randomized and double-blind with an interval of 7 days between the infusions. During PGI₂ infusion systolic blood pressure fell significantly from 147.8±4.8 mm Hg to 140.6±4.0 mm Hg (P<0.01) and returned to 144.5±4.9 mm Hg post infusion. Transcutaneous p₂^O (tcp₂^O) measured on the instep of the affected limb increased significantly by 8.9±3.8 Torr during PGI₂ infusion and remained elevated during the subsequent week. A significant reduction of pain was observed from the 5th day of PGI₂ infusion, lasting for at least the following observation period. Platelet cAMP increased from 18.8±1.5 pmol/10⁸ platelets to 24.7±1.6 pmol/10⁸ platelets on the 3rd day of PGI₂ infusion (P<0.01). Spontaneous platelet aggregation was also significantly reduced during PGI₂ infusion. However, 7 days after the infusion thromboxane B₂ (TXB₂) in plasma and spontaneous platelet aggregation significantly increased in comparison with the preinfusion values, indicating a rebound phenomenon. The clinical outcome was favorable in 9 of 12 patients, was unchanged in two patients, while progressing to limb amputation in one patient.Abkürzungsverzeichnis TXA₂ Thromboxane A₂ - PGI₂ Prostacyclin - PVD Peripheral Vascular Disease - tcpO₂ transcutaneous pO₂ - VAS Visual Analog Scale - PAT III Platelet Aggregation Test III by Breddin - HDL high density lipoprotein - AT III antithrombin III - SFMC Soluble fibrinogen-fibrin monomer complexes - PAR platelet aggregation ratioFor Professor Dr. W. Kaufmann on his 60th GeburtstagSupported by the Landesamt für Wissenschaft und Forschung, NRW