The effects of iloprost (a prostocycline analogue) on the endothelial dysfunction and clinical outcomes in diabetic foot ulcers

The Effects of Iloprost (A Prostocycline Analogue) On the EndothelialDysfunction and Clinical Outcomes in Diabetic Foot UlcersEndothelial dysfunction and atherosclerosis are frequent pathologies seen amongdiabetic patients and may progressively lead to tissue ischemia. Especially, if there is anischemia at a critical level secondary to peripheric arterial disease in patients withdiabetic foot ulcers, clinical pictures even evolving to amputations may be encountered.In this situation, it is quite important to provide revascularization. But, all of the patientsmay not be suitable for vascular surgery and/or angioplasty.İn this study, we gave iloprost (Prostocycline analogue) with an infusion rate of0.5-2 ng/kg/min for 10 days to patients with diabetic foot ulcers who can?t berevascularized while having serious signs and symptoms of ischemia and studied it?seffects on endothelial dysfunction and clinical outcomes.Sixty patients (36 male, 24 female, with mean age of 61,8 ± 9,2) and 15 healtycontrols (9 male, 6 female, with median age of 60,7 ± 9,1) are included in our studyWhile iloprost was given to 30 of patients, others were treated in a same manner otherthan iloprost. Before and after treatment (10th day and 1st month), endothelial functionsof patients and healty controls were evaluated with brachial arterial FMD (FlowMediated Dilation) method. Two groups were compared for hospitalization period,duration of antibiotherapy and amputation rates. Being different from healthy controls,endothelial dysfunction was detected in diabetic patients before iloprost treatment(P=0.276). After 10 days of treatment with iloprost and especially in the first month oftreatment, favourable improvements were observed in endothelial functions (P=0.002).İn iloprost group, no additional improvement was seen in hematologic and biochemicalparameters while hospitalization period (p=0.390), duration of antibiotherapy (p=0.276)and also amputation rates (p=0.097) were improved although not significantstatistically.In conclusion, we feel that, for patients with peripheric arterial disease at acritical level of ischemia and not applicable for revascularization, iloprost treatmentmay have positive effects on clinical outcomes. Further large group studies are neededto elicit the effects of iloprost to clinical results.Key words: Diabetes, Atherosclerosis, Foot ulcer, Peripheric Arterial Disease,Endothelial Dysfunction, İloprost