Intraindividual evaluation of the optimal PGE₁ application route in critical limb ischemia

Abstract

Since prostaglandin E₁ was first used for the treatment of critical limb ischemia, the best route of administration—intraarterial (i.a.) or intravenous (i.v.)—has not yet been determined. The aim of this study was to compare the effects of i.a. and i.v. prostaglandin E₁ (PGE₁) infusions on transcutaneous partial pressure of oxygen (tcPO₂) on a within-patient basis in patients with critical limb ischemia. In a randomized, crossover study, 20 patients with critical limb ischemia were treated with a 30-minute i.a. infusion of 10 μg PGE₁ in 25 ml saline and a 60-minute i.v. infusion of 40 μg PGE₁ in 125 ml saline. During i.a. infusion of PGE₁, the mean tcPO₂ (forefoot) decreased significantly from 12.2 mmHg to 3.3 mmHg (−73%,p < 0.001). In contrast, during i.v. infusion of PGE₁, tcPO₂ (forefoot) increased significantly from 8.9 mmHg to 16.3 mmHg (+83.1%,p < 0.001). Administration by both routes also increased tcPO₂ measured at the forefoot of the contralateral limb. These results demonstrate that i.v. administration of PGE₁ in contrast to the i.a. route significantly improves oxygen supply to the skin, and therefore should be considered superior to i.a. administration.