PENTOXIFYLLINE AND CRITICAL LEG ISCHEMIA

The annual incidence of critical leg ischemia has been estimated at 50 0-1,000 patients per million population/year. In critical ischemia the re is a breakdown in the microvascular flow-regulating system and inap propriate activation of the microvascular defense system, with resulta nt endothelial damage and activation of platelets and leukocytes, whic h leads to further damage of the capillary network. The mainstay of tr eatment until recently has consisted of interventional procedures. How ever, these are not always feasible and are not without significant mo rtality and morbidity. Therefore, attention has been directed towards pharmacologic management. Pentoxifylline inhibits leukocyte aggregatio n and activation, and improves red cell deformability and oxygen relea se to tissue. On the basis of these properties, several pilot studies were undertaken, and most have confirmed the benefits of pentoxifyllin e in the management of critical ischemia. These positive results led t o the initiation of a multicenter, double-blind, placebo-controlled st udy of intravenous pentoxifylline in the acute management of critical ischemia. Results showed a significant reduction in rest pain with pen toxifylline, and outcome was not influenced by various prognostic fact ors. Research to date suggests that pentoxifylline could have a defini te role in the management of patients with critical ischemia.