Acute limb ischemia in elderly patients: can iloprost be useful as an adjuvant to surgery? Results from the ILAILL study.
OBJECTIVE
To evaluate the effects of iloprost, in addition to surgery, on the outcome of acute lower limb ischemia (ALLI).


METHODS
Post-hoc analysis of a randomized, double-blind, placebo-controlled study.


METHODS
In the context of the ILAILL (ILoprost in Acute Ischemia of Lower Limbs) study, 192 elderly patients (>70 years old) undergoing surgery for ALLI were assigned to receive perioperative iloprost (intra-arterial, intra-operative bolus of 3000 ng, plus intravenous infusion of 0.5-2.0 ng/kg/min for six hours/day for 4-7 days following surgery), or placebo (iloprost: n=100; placebo: n=92). Patients were followed-up for three-months following surgical revascularization.


RESULTS
The combined incidence of death and amputation (primary study end-point) was significantly reduced in patients treated with iloprost (16.0% vs 27.2% in the placebo group; hazard ratio 1.99, 95% confidence interval 1.05-3.75, p=0.03). A statistically significant lower mortality (6.0%) was reported in patients receiving iloprost, compared to controls (15.2%) (hazard ratio 2.93, 1.11-7.71, p=0.03). The overall incidence of death and major cardiovascular events was lower in patients receiving iloprost compared to those assigned placebo (24.0% and 35.9%, respectively), at the limits of statistical significance (relative risk 1.64, 0.97-2.79, p=0.06).


CONCLUSIONS
These results confirm the poor outcome in elderly patients with ALLI. Based on a subgroup analysis iloprost, as an adjuvant to surgery, appears to reduce the combined end-point of death and amputation.
de Donato
G
G
Department of Vascular Surgery, San Giovanni Bosco Hospital, II University of Naples, Italy. dedonato@unisi.it
Gussoni
G
G
de Donato
G
G
Cao
P
P
Setacci
C
C
Pratesi
C
C
Mazzone
A
A
Ferrari
M
M
Veglia
F
F
Bonizzoni
E
E
Settembrini
P
P
Ebner
H
H
Martino
A
A
Palombo
D
D
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D004311:Double-Blind Method; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006801:Humans; D016285:Iloprost / Q000627:therapeutic use*; D015994:Incidence; D007511:Ischemia / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D002317:Cardiovascular Agents; D016285:Iloprost