[Tolerance and therapeutic results of iloprost in obliterative arteriopathy in lower limbs at the severe chronic ischemia stage. A retrospective study of 29 consecutive cases].
[Tolerance and therapeutic results of iloprost in obliterative arteriopathy in lower limbs at the severe chronic ischemia stage. A retrospective study of 29 consecutive cases].
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伊洛前列素治疗严重慢性缺血期下肢闭塞性动脉病的耐受性及治疗效果。
DOI：
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发表时间：
2000
影响因子：
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通讯作者：
H. Lévesque
中科院分区：
文献类型：
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作者：
S. Duthois;N. Cailleux;H. Lévesque
这项回顾性研究的目的是评估稳定的前列环素（伊洛前列素）类似物在严重形式的永久性下肢缺血中的耐受性和治疗效果。连续 90 名未经选择的 Leriche 和 Fontaine III 期或 IV 期患者在血管造影后拒绝接受血管手术并接受伊洛前列素治疗 28 天，被纳入该研究。对患者进行临床随访（缺血性疼痛、营养变化、步行距离）和经皮血氧测定（D28）。长期评估（平均2年）以死亡率、大截肢率和“肢体存活率”表示。没有伊洛前列素不耐受的表现。两个月时，90 名患者中有 42 名 (47%) 被认为是有反应者，因为疼痛没有 (n = 36) 或显着减轻 (n = 6)、营养性病变减少和保守步行。在长期（6个月、一年和两年），我们观察到分别有10（11%）、17（20%）和22（25%）名患者死亡，24（27%）、26（30%）和28（32%）名患者接受了大截肢，但60（68%）、54（62%）和49（56%）名患者仍然活着，肢体和保守行走。没有发现预测因素，但没有微血管病变或最近发生搭桥闭塞的糖尿病患者（分别有 43% 和 56% 的患者在 6 个月时肢体存活）与不良结果相关。这项回顾性研究尽管有其局限性，但强调了伊洛前列素在非手术慢性严重缺血中的良好耐受性和有效性。然而，除了初始临床严重程度和治疗后一个月的临床变化外，无法建立长期疗效的预测标准。
The aim of this retrospective, study was to assess the tolerance and therapeutic effect of a stable prostacyclin (iloprost) analog in severe forms of permanent lower limb ischemia. Ninety consecutive unselected patients, in Leriche and Fontaine stages III or IV, turned down for vascular surgery after angiography and treated with iloprost for 28 days were enrolled in the study. Patients were followed up clinically (ischemic pain, trophic changes, walking distance) and with transcutaneous oxymetry (D28). Long-term assessment (mean 2 years) was expressed as rates of death, major amputation and "patients alive with limb". There were no manifestations of intolerance to iloprost. At two months, 42 out of 90 patients (47%) were considered as responders because of a lack (n=36) or significant decrease (n=6) in pain, reduction of trophic lesions and conservative walking. At long term (6 months, one and two years) we observed that 10 (11%), 17 (20%) and 22 (25%) patients respectively had died, 24 (27%), 26 (30%) and 28 (32%) patients underwent major amputation, but 60 (68%), 54 (62%) and 49 (56%) patients still alive with their limb and conservative walking. No predictive factors were noted, but diabetic patients without microangiopathy or recent bypass occlusions (respectively 43% and 56% out of patients were alive with limb at 6 months) were associated with bad results. This retrospective study, despite its limitations, underlines the good tolerance to, and effectiveness of iloprost in non surgical chronic critical ischemia. However, no predictive criterion of long-term effectiveness could be established, except initial clinical severity and clinical change one month after treatment.