Acute limb ischemia in elderly patients: Can iloprost be useful as an adjuvant to surgery? Results from the ILAILL study
| Autor: | de Donato G, Gussoni G, Cao P, Setacci C, Pratesi C, Mazzone A, Ferrari M, Veglia F, Bonizzoni E, Settembrini P, Ebner H, Martino A, Palombo D, Paroni G, Odero A, de Laurentiis R, Bianco G, Baldi I, Pulli R, Romano E, la Marca G, Sbraga P, Zaraca F, Spinelli F, Mandolfino T, Benedetto F, Baccellieri D, Adami D, Del Corso A, Ruggieri M, Novali C, Mangiacotti B, Ponzio F, Capaldi G, Parente B, Parlani G, Maltempi P, Ferrero S, Colotto P, Nardella L, Pastorino S, Rauti G, Marone EM, Setacci F, Bertoglio C, Caristiani AM, Carissimi T, Deriu G, Antonello M, Nessi F, Cumbo P, Ferrero E, Mattassi R, Callini E, Ippoliti A, Ascoli Marchetti A, di Giulio L, Spartera C, Petrassi C, Saracino G, Biasi G, Mingazzini P, Regina G, Impedovo G, Lillo A, Angiletta D, Marotta V., CHIESA , ROBERTO, TSHOMBA, YAMUME |
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| Přispěvatelé: | de Donato, G, Gussoni, G, Cao, P, Setacci, C, Pratesi, C, Mazzone, A, Ferrari, M, Veglia, F, Bonizzoni, E, Settembrini, P, Ebner, H, Martino, A, Palombo, D, Paroni, G, Odero, A, de Laurentiis, R, Bianco, G, Baldi, I, Pulli, R, Romano, E, la Marca, G, Sbraga, P, Zaraca, F, Spinelli, F, Mandolfino, T, Benedetto, F, Baccellieri, D, Adami, D, Del Corso, A, Ruggieri, M, Novali, C, Mangiacotti, B, Ponzio, F, Capaldi, G, Parente, B, Parlani, G, Maltempi, P, Ferrero, S, Colotto, P, Nardella, L, Pastorino, S, Rauti, G, Chiesa, Roberto, Marone, Em, Setacci, F, Bertoglio, C, Caristiani, Am, Carissimi, T, Deriu, G, Antonello, M, Nessi, F, Cumbo, P, Ferrero, E, Mattassi, R, Callini, E, Ippoliti, A, Ascoli Marchetti, A, di Giulio, L, Spartera, C, Petrassi, C, Saracino, G, Biasi, G, Mingazzini, P, Tshomba, Yamume, Regina, G, Impedovo, G, Lillo, A, Angiletta, D, Marotta, V. |
| Rok vydání: | 2007 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Acute limb ischemia Elderly patients Iloprost Reperfusion Surgical revascularization Acute Disease Aged Aged 80 and over Cardiovascular Agents Chemotherapy Adjuvant Double-Blind Method Extremities Female Humans Incidence Ischemia Kaplan-Meier Estimate Proportional Hazards Models Risk Factors Treatment Outcome Amputation Vascular Surgical Procedures Surgery Cardiology and Cardiovascular Medicine Placebo Amputation Surgical Bolus (medicine) medicine 80 and over Chemotherapy Adjuvant Medicine(all) business.industry Hazard ratio Perioperative Acute limb ischemia Elderly patients Iloprost Reperfusion Surgical revascularization Relative risk Cardiovascular agent acute limb ischemia elderly patients iloprost business medicine.drug |
| Popis: | Objectives To evaluate the effects of iloprost, in addition to surgery, on the outcome of acute lower limb ischemia (ALLI). Design Post-hoc analysis of a randomized, double-blind, placebo-controlled study. Methods In the context of the ILAILL (ILoprost in Acute Ischemia of Lower Limbs) study, 192 elderly patients (>70 years old) undergoing surgery for ALLI were assigned to receive perioperative iloprost (intra-arterial, intra-operative bolus of 3000ng, plus intravenous infusion of 0.5–2.0ng/kg/min for six hours/day for 4–7 days following surgery), or placebo (iloprost: n =100; placebo: n =92). Patients were followed-up for three-months following surgical revascularization. Results The combined incidence of death and amputation (primary study end-point) was significantly reduced in patients treated with iloprost (16.0% vs 27.2% in the placebo group; hazard ratio 1.99, 95% confidence interval 1.05–3.75, p =0.03). A statistically significant lower mortality (6.0%) was reported in patients receiving iloprost, compared to controls (15.2%) (hazard ratio 2.93, 1.11–7.71, p =0.03). The overall incidence of death and major cardiovascular events was lower in patients receiving iloprost compared to those assigned placebo (24.0% and 35.9%, respectively), at the limits of statistical significance (relative risk 1.64, 0.97–2.79, p =0.06). Conclusions These results confirm the poor outcome in elderly patients with ALLI. Based on a subgroup analysis iloprost, as an adjuvant to surgery, appears to reduce the combined end-point of death and amputation. |
| Databáze: | OpenAIRE |
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