[Critical ischemia in elderly patients. Evaluation of the effect of two different methods of Iloprost therapy on the efficacy, tolerance, modification of quality of life and self-sufficiency].
BACKGROUND
The use of Iloprost in the treatment of critical leg ischemia in very old patients can lead to tolerability problems, related to the drug used and to the kind of patient treated. The aim of this study was to evaluate the impact of this therapy on the activities of daily living and on the quality of life of the patient together with its efficacy and tolerability.


METHODS
We studied 20 subjects (mean age 74 +/- 6.8) divided in 2 groups homogeneous for age, seriousness of the disease and presence of diabetes mellitus. In the first group Iloprost was administered for 6 hours, for 28 consecutive days, in the second group for 6 hours, two times a day for 14 consecutive days. In each group we observed the following parameters before and after treatment: clinical evaluation of pain and use of analgesics, ADL and SK39 questionnaire, ankle/arm index c.w. Doppler, strain gauge plethismography of lower limbs, TcPO2 at the back-feet level.


RESULTS
Treatment was well tolerated in both groups where we observed a similar reduction of pain, a reduction in the instrumental indexes which express the microcirculatory activity, an improvement in the quality of life and in the capacity to carry out everyday activities. The double daily administration of Iloprost did not cause any significant side effect in the subjects studied, and a better responsiveness to the pain symptomatology was observed.


CONCLUSIONS
Iloprost can be used in the treatment of critical leg ischemia even for very old patients with good tolerability and effectiveness. In the double daily administration no relevant side effect was observed. This approach is to be preferred also in terms of cost-effectiveness.
Cappelli
R
R
Bicchi
M
M
Arrigucci
S
S
Boschi
S
S
Guerrini
M
M
Forconi
S
S
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000375:Aging; D001157:Arterial Occlusive Diseases / Q000188:drug therapy; D005260:Female; D006801:Humans; D016285:Iloprost / Q000494:pharmacology / Q000627:therapeutic use*; D007511:Ischemia / Q000188:drug therapy*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011788:Quality of Life; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D016285:Iloprost
L'anziano arteriopatico con ischemia critica. Valutazione del trattamento con iloprost secondo due diverse modalità, sulla efficacia e tollerabilità, sulle modificazioni della qualità di vita e dell'autosufficienza.