Iloprost Use in Patients with Persistent Intestinal Ischemia Unsuitable for Revascularization.
BACKGROUND
Persistent or chronic intestinal ischemic injury (i3) can lead to severe malnutrition and acute mesenteric ischemia. Although recommended, revascularization of splanchnic arteries is sometimes unrealizable.


METHODS
We report a case series of iloprost use in consecutive stable patients with persistent i3 unsuitable for revascularization followed in a tertiary care center. The feasibility of revascularization was discussed and ruled out by a multidisciplinary team, and informed consent was obtained prior to consideration of a vasoactive therapy. Therapeutic response was defined at 6 months by a decrease in the use of analgesic and parenteral nutrition, and no need for intestinal resection.


RESULTS
Between 2006 and 2015, 6 patients (mean age: 51) were included. Splanchnic vascular insufficiency was due to superior mesenteric artery (SMA) thrombosis (n = 4), dissection of the celiac trunk and SMA (n = 1), or repeated vasospasm resulting in chronic nonocclusive mesenteric ischemia (n = 1). Iloprost was delivered via continuous intravenous perfusion at a maximum dosage of 2 ng/kg/min for 6 hours/day on 4 consecutive days, without severe adverse events. Therapeutic response was observed in 4 patients, 3 of which completely stopped parenteral nutrition and analgesic with no need for intestinal resection.


CONCLUSIONS
Our results are consistent with findings of a favorable effect of iloprost in patients with persistent splanchnic ischemia that should be confirmed in prospective trials.
Department of Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, France; Paris 7-Diderot University, Paris, France; Laboratory for Vascular Translational Science-Inserm U1148, Bichat Hospital, Paris, France. Electronic address: alexandre.nuzzo@aphp.fr.
Alexandre
A
Nuzzo
Department of Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, France; Paris 7-Diderot University, Paris, France.
Damien
D
Soudan
Department of Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, France; Paris 7-Diderot University, Paris, France.
Lore
L
Billiauws
Paris 7-Diderot University, Paris, France; Department of Pharmacy, Beaujon Hospital, Clichy, France.
Julie
J
Bataille
Paris 7-Diderot University, Paris, France; Department of Colorectal Surgery, Beaujon Hospital, Clichy, France.
Léon
L
Maggiori
Paris 7-Diderot University, Paris, France; Department of Radiology, Beaujon Hospital, Clichy, France.
Maxime
M
Ronot
Paris 7-Diderot University, Paris, France; Department of Pharmacy, Beaujon Hospital, Clichy, France.
Jeanick
J
Stocco
Department of Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, France; Paris 7-Diderot University, Paris, France.
Yoram
Y
Bouhnik
Paris 7-Diderot University, Paris, France; Department of Pharmacy, Beaujon Hospital, Clichy, France; Department of Vascular Surgery, Bichat Hospital, Paris, France.
Yves
Y
Castier
Department of Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, France; Paris 7-Diderot University, Paris, France; Laboratory for Vascular Translational Science-Inserm U1148, Bichat Hospital, Paris, France.
Olivier
O
Corcos
D000700:Analgesics / Q000627:therapeutic use; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016285:Iloprost / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D012189:Retrospective Studies; D013152:Splanchnic Circulation / Q000187:drug effects; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
D000700:Analgesics; D014665:Vasodilator Agents; D016285:Iloprost