Intravenous hydroxyethylrutosides combined with long-term oral anticoagulation in atherosclerotic nonreconstructable critical leg ischemia: A retrospective study

Objective. To evaluate in a group of seriously diseased patients with nonre constructable chronic critical leg ischemia (CLI), treated by a combination of IV hydroxyethylrutosides (HR)* and oral anticoagulation (AC) by warfari n, the short-term effects on the cutaneous microvascular blood perfusion of the soles of feet and especially the long-term clinical outcome in terms o f amputation and death. Design. A retrospective comparison between two groups of patients, HR + AC and a comparable reference group, fulfilling the same inclusion and exclusi on criteria corresponding to the definition of CLI according to the Second European Consensus Document (1991). Clinical follow-up in both groups was m ade after 1, 3, 6, 12, and 24 months. Setting. Patients were examined at university departments of clinical physi ology with special interest in peripheral vascular disease, in cooperation with colleagues at university departments of surgery, internal medicine and dermatology of Karolinska Hospital, Sodersjukhuset and Huddinge Hospital. Patients, A total of seventy patients with CLI according to the definition of the Second European Consensus Document, 1991, ie, besides severe rest pa in or ischemic lesions also a toe blood pressure <30 mg Hg. Group with HR anticoagulation (AC): 42 patients (19 diabetics, 23 nondiabetics). Referen ce group: 28 patients (18 diabetics, 10 nondiabetics). For distribution of age and toe blood pressure at baseline, see Table I. Interventions. Therapy group: besides ordinary standard therapy, daily HR i nfusions for a mean period of 3.6 weeks + oral anticoagulation continued to the end of the study at 24 months. A comparable reference group on the sam e basic therapy but without the combination HR + AC. Parameters In Evaluation. Short-term parameters: clinical data, skin temper ature, and fluorescein imaging, Long-term outcome: amputation or death. Results. Short-term and long-term results with HR + AC indicated that patie nts with severe CLI and very poor prognosis benefited in terms of survival and limb salvage from initial therapy with HR infusion combined with long-t erm oral anticoagulation. Results of this combined treatment seem at least comparable with those with IV prostacyclin analogies.