SKIN OXYGEN-PRESSURE HISTOGRAMS IN PATIENTS WITH PERIPHERAL ARTERIAL OCCLUSIVE DISEASE DURING INTRAARTERIAL AND INTRAVENOUS PROSTAGLANDIN E(1) INFUSIONS OF DIFFERENT DOSAGES AND THEIR PROGNOSTIC VALUE

Skin surface oxygen pressure fields (tcPO(2) [37 degrees C]) reproduci bly characterize skin microcirculation in patients with peripheral art erial occlusive disease. These appear suited for investigation of shor t- and long-term effects of vasoactive drug treatment. The authors stu died whether skin surface oxygen pressure histograms change depending on dosage and route of administration of prostaglandin E(1) (PGE(1)), whether they are of predictive value for patients' clinical outcome, a nd whether they normalize after therapy with PGE(1). The authors inves tigated 15 patients with various degrees of disease and measured foref oot oxygen histograms consisting of at least 80 single tcPO(2) (37 deg rees C) values before and during intraarterial infusion (1.5, 3, or 6 ng/kg/minute) and intravenous infusion (4.5, or 9 ng/kg/minute). The m easurements were repeated two and six hours after the end of intraarte rial application of 1.5 ng/kg/minute. Furthermore, the orthostatic vas oconstrictor response was tested. Skin oxygen pressure histograms were controlled after a period of twenty-two (mean) days of intraarterial PGE(1) therapy. Resting histograms were left shifted with median tcPO( 2) (37 degrees C) between 1 and 7 mm Hg. During intraarterial applicat ion, histograms were shifted to lower tcPO(2) (37 degrees C) values in most patients. Only in 3 diabetic subjects with proximal or acral obl iterations was a marked increase observed. The alterations were detect able at least two hours after the end of the infusion. During intraven ous infusion, histograms did not change in most cases. After long-term therapy, histograms were substantially unchanged. A pathologic vasoco nstrictor response, which was present in 10 patients, could not be res tored. Despite a marked deterioration of the histograms the clinical o utcome was favorable in 7 patients. Patients with a high resting tcPO( 2) (37 degrees C) (median 4 mm Hg and more) and those with a vasoconst riction on orthostasis are likely to respond to PGE(1) therapy.