Prostaglandins in Critical Limb Ischaemia

Management of patients with intermittent claudication and chronic critical limb ischaemia (CLI) should take into account the general prognosis as well as progression of the disease. Reducing the known risk factors for the development of atherosclerosis is still the mainstay of therapy in claudicants. They should refrain from smoking, follow an appropriate diet and have hypertension and diabetes tightly controlled. The same is true for patients with CLI but is not enough for the most serious phase of peripheral arterial obstructive disease (PAOD). What then is the place of drugs in the primary medical care of patients with a limbthreatening condition such as CLI? There is a theoretical rationale for induced hypertension, hyperbaric oxygen, heparin, systemic or regional thrombolysis, defibrinogenation, haemodilution, vasoactive drugs, lumbar sympathetic block and epidural spinal cord stimulation. Published studies of such agents have been reviewed.t? From a strict scientific point of view it is however not proven that any of the drugs or methods mentioned above is effective in the severe clinical condition of CLI as defined in the Consensus Document. Based on case reports, continuous intra-arterial infusion with PGE1 suggested some benefit might be obtained for patients with severe peripheral