phenprocoumon and Intermittent-Claudication

To determine whether long-term oral anticoagulant treatment was effective in improving graft performance and preventing major amputation following vein bypass surgery for femoropopliteal atherosclerosis, a clinical trial was conducted in one single center and continued during 10 years. After 130 patients had electively received a femoropopliteal vein graft, they were randomly assigned to a therapy group (treatment with phenprocoumon [n = 66]) or to a control group (n = 64) that remained without any anticoagulant treatment. Primary end points of the study were graft reocclusion and limb loss. The median durations of primary patency and limb salvage were significantly longer for treated patients than that for controls. In addition, survival in the therapy group was longer. Following autologous vein bypass surgery in the treated group, the results were superior in terms of graft patency, limb salvage, and survival.

Topics: Administration, Oral; Aged; Arteriosclerosis; Blood Coagulation Tests; Female; Femoral Artery; Follow-Up Studies; Gangrene; Graft Occlusion, Vascular; Humans; Intermittent Claudication; Male; Middle Aged; Phenprocoumon; Popliteal Artery; Pulse; Saphenous Vein; Survival Rate; Tablets; Vascular Patency

Persistent sciatic artery (PSA) is a rarely seen variation of the lower limb vessels. Anatomically the PSA is the continuation of internal iliac arteries. It follows the sciatic nerve from the sciatic foramen to the level of the knee. We report our experience with conservative therapy in a patient with complete occlusion of a PSA. A 54-year-old man with typical symptoms of intermittent claudication on the left limb was referred to our Department. After clinical examination Doppler and duplex sonography were performed. Angiography showed bilateral PSA. On the left side the PSA was occluded. The patient received 20 intravenous courses of prostaglandin E1 for 4 weeks, followed by oral anticoagulation with phenprocoumon for life (INR: 2.5-3.5). After 3 years therapy he does not show any typical symptoms of intermittent claudication or limb ischemia. This case shows that conservative therapy may be effective. However, it has to be emphasised that this approach requires frequent clinical and duplex sonography follow-up every 3 to 6 months with oral anticoagulation.

Topics: Alprostadil; Angiography; Anticoagulants; Femoral Artery; Fibrinolytic Agents; Humans; Iliac Artery; Intermittent Claudication; Leg; Male; Middle Aged; Phenprocoumon; Popliteal Artery; Sciatic Nerve; Sciatic Neuropathy; Tibial Arteries