title: Phosphodiesterase inhibitors in vascular ischemia: A case report and review of their use in ischemic conditions.
abstract: The treatment of digital ischemia remains difficult. Sildenafil (Viagra, Pfizer UK), a selective phosphodiesterase inhibitor, increases blood flow and is currently marketed for the treatment of erectile dysfunction. A case of a 57-year-old man with progressive episodic ischemia and pain of the fingertips resulting in finger tip ulceration is presented. After failure of medical and surgical management, a trial of oral sildenafil resulted in marked symptomatic improvement of his bilateral digital ischemia. Review of the literature shows that, particularly in patients with an underlying disease such as sclero-derma with a vasospastic component, a marked improvement in digital blood flow may be observed with sildenafil use. Overall, based on a number of case reports and preliminary animal studies in the literature, sildenafil appears to have a growing significance in the treatment of hand ischemia. Similarly, there is evidence that phosphodiesterase 5 inhibitors may be used as an adjunct to improving skin flap survival.
authors.affiliation: The Hand and Upper Limb Centre;
authors.forename: Wendy Ky
authors.initials: WK
authors.lastname: Ng
authors.forename: Yishai
authors.initials: Y
authors.lastname: Rosenblatt
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Brock
authors.forename: David B
authors.initials: DB
authors.lastname: O'Gorman
authors.forename: Bing
authors.initials: B
authors.lastname: Siang Gan