iloprost and Embolism

Thromboangiitis obliterans (Buerger's disease) is an inflammatory obliterative, nonatherosclerotic, vascular disease that affects the small- and medium-sized arteries, veins, and nerves. It is causally related to tobacco use, although the exact mechanism is unknown. Its clinical presentation is manifested by distal arterial ischemia and superficial thrombophlebitis. Thromboangiitis obliterans usually becomes quiescent if the patient is able to stop smoking cigarettes. However, if smoking continues, amputation commonly results.

Topics: Amputation, Surgical; Arteriosclerosis; Diagnosis, Differential; Embolism; Female; Humans; Iloprost; Male; Smoking; Thromboangiitis Obliterans

The authors hypothesized that the emergence of painful bone marrow edema occurs through microembolisms in the bone marrow that may be reflected in elevated plasma parameters of hypofibrinolysis or a disturbance of the lipid metabolism and that treatment with iloprost may lead to a decrease in or normalization of the elevated serum parameters and, therefore, to pain reduction. Twenty-one patients (12 men and 9 women; mean age, 50 years [range, 22-70 years]) with painful bone marrow edema and elevated lipoprotein(a) (Lp[a]) serum values were treated with intravenous iloprost. Before and 6 weeks after iloprost therapy, the serum concentrations of Lp(a), apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined. At 6-week follow-up, 17 patients reported complete resolution of their symptoms. For these patients, complete bone marrow edema resolution was observed on magnetic resonance imaging. Four patients reported that their symptoms were either the same or had worsened but had partial bone marrow edema resolution on magnetic resonance imaging. In these patients, Lp(a) values either increased or remained the same. Hence, the total success rate of iloprost treatment was 86% at a mean follow-up of 17 months (range, 3-45 months). Before iloprost therapy, mean ApoA1, ApoB, and Lp(a) values were 159.8, 108.3, and 69.1 mg/dL, respectively. Six weeks after iloprost therapy, mean ApoA1, ApoB, and Lp(a) values decreased to 147.6 (P=.011), 98.4 (P=.042), and 38.3 (P<.001) mg/dL, respectively. The results of this study indicate a possible role of hypofibrinolysis or a disturbance in the lipid metabolism in the emergence of painful bone marrow edema.

Topics: Adult; Aged; Apolipoproteins; Bone Marrow Diseases; Edema; Embolism; Female; Humans; Iloprost; Infusions, Intravenous; Male; Middle Aged; Prospective Studies; Vasodilator Agents; Young Adult

A 66-year-old woman presented with acute-onset rapid atrial fibrillation and right upper quadrant pain which had appeared 24 h prior to admission. The patient also manifested acute oliguric renal failure (serum creatinine 6.9 mg/dl). Selective renal angiography revealed total occlusion of the right renal artery with normal visualization of the left kidney vasculature. The patient was treated with intra-arterial urokinase and intravenous heparin, with no response. Intravenous administration of the prostacyclin analogue, iloprost, resulted in rapid resolution (within hours) of the oliguric acute renal failure, in spite of the continuing presence of a nonfunctioning right kidney. We conclude that the etiology of the acute renal insult in this patient is probably related to unilateral renal arterial embolization accompanied by arterial spasm of the unaffected kidney. The contralateral vasospasm can be reversed by iloprost, which then leads to a rapid recovery from acute renal failure. We are unaware of prior reports documenting the beneficial effect of iloprost in a clinical setting as described here.

Topics: Acute Kidney Injury; Aged; Atrial Fibrillation; Embolism; Female; Humans; Iloprost; Oliguria; Renal Artery Obstruction; Rheumatic Heart Disease; Vasodilator Agents

Cholesterol embolisation is a little known complication of aortic surgery and radiological procedures with a mortality of 81%. Treatment has been poorly described and inadequate. We report a case in which we have followed an aggressive policy of treatment using modern vascular techniques not previously described in this condition.

Topics: Angiography; Aorta, Abdominal; Arteriovenous Fistula; Blood Vessel Prosthesis; Cholesterol; Combined Modality Therapy; Drug Therapy, Combination; Embolism; Femoral Artery; Humans; Iloprost; Injections, Intra-Arterial; Intermittent Claudication; Ischemia; Leg; Male; Middle Aged; Postoperative Complications; Pulse; Reoperation; Streptokinase