Vasodilator Response Correlates with Outcome in Chronic Critical Limb Ischemia

Background. There are few predictors of limb salvage in patients with critical limb ischemia (CLI). We evaluated the accuracy of correlation of skin perfusion pressure (SPP) measurements in response to vasodilation to clinical outcome. Methods. Patients with CLI were evaluated by SPP at baseline. After injection of the vasodilator alprostadil, SPP was re-evaluated at 120 min and at day 7. Results. Patients showing clinical improvement demonstrated increased SPP in response to vasodilation (120 min: 34.12 +/- 2.44 to 48.33 +/- 3.41 mm Hg, P < 0.01; day 7: 33.13 +/- 3.14 to 45.83 +/- 3.79 mm Hg, P < 0.01), whereas patients who clinically deteriorated demonstrated no increase in SPP (120 min: 30.00 +/- 2.67 to 35.00 +/- 2.31 mm Hg, P = 0.086; day 7: 35.00 +/- 3.54 to 27.5 +/- 4.33 mm Hg, P = 0.22). Conclusions. Prognosis for limb salvage correlated with SPP improvement post-vasodilator treatment after both early and late time points. Measurement of SPP after vasodilator treatment may be clinically useful in the treatment of patients with CLI. A multi-center trial of SPP in response to vasodilators is warranted. (C) 2010 Elsevier Inc. All rights reserved.