Limb Salvage Instead of Amputation in 10 Cases of Nonreconstructible "End-Point Ischemia" Treated with IV Hydroxyethylrutosides Plus Oral Anticoagulation

Abstract

The authors report on limb salvage in 10 cases of "end-point ischemia," already scheduled for urgent amputation, selected from a group of 42 atherosclerotic cases with critical limb ischemia according to the definition of the Second European Consensus Document on Critical Limb Ischemia.(1) Patients were treated for 3 to 4 weeks with intravenous infusions of the rheologic, antioxidant and endotheliumprotective flavonoid mixture 0-(beta-hydroxyethyl)- rutosides (HR) (Venoruton; Zyma, now Novartis) which improves microvascular blood perfusion and possesses antiedematous effects. The infusions were combined with oral anticoagulation (Waran ®) which was continued afterwards as long-term treatment for at least 2 years. In some cases anticoagulation was later replaced by low-dose aspirin. A statistically significant favorable effect was found for both limb salvage and survival—the 10 selected cases of limb salvage in spite of "end-point ischemia" also included 1 uremic case on hemodialysis with very severe rest pain and toe necrotization. Improved microcirculation following soon after the start of treatment was observed in all 10 cases as well as an often very rapid alleviation of rest pain and beginning healing of ischemic lesions. The follow-up showed a preservation of the threatened limb for a mean time of 7.9 years in the atherosclerotic group and, in spite of high age at start of treatment (mean age 72 years), an apparently long survival of those patients who had died, on average 7.7 years. Because side effects are rare and there is a rapid allevia tion of rest pain, it may be possible to give the HR infusions safely on an ambulatory basis in the out-patient department.