Tolerance and therapeutic results of iloprost in severe chronic ischemia of the lower limbs. A report on 90 patients.

The aim of this retrospective, study was to assess the tolerance and therap eutic effect of a stable prostacyclin (iloprost) analog in severe forms of permanent lower limb ischemia. Ninety consecutive unselected patients, in L eriche and Fontaine stages III or IV, turned down for vascular surgery afte r angiography and treated with iloprost for 28 days were enrolled in the st udy. Patients were followed up clinically (ischemic pain, trophic changes, walking distance) and with transcutaneous oxymetry (D28). Long-term assessm ent (mean 2 years) was expressed as rates of death, major amputation and "p atients alive with limb". There were no manifestations of intolerance to iloprost. Ar 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 lesion s and conservative walking. At long term (6 months, one and two years) we o bserved 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 co nservative 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 tole rance to, and effectiveness of iloprost in non surgical chronic critical is chemia. However, no predictive criterion of long-term effectiveness could b e established, except initial clinical severity and clinical change one mon th after treatment.