Profile of patients with the best response to alprostadil in peripheral obstructive arterial disease

Abstract

Introduction: Peripheral Arterial Occlusive Disease (PAOD) is a condition characterized by the narrowing of peripheral arteries due to atherosclerosis, leading to impaired blood flow and intermittent claudication. Although first-line treatments are surgical, patients with contraindications require pharmacological therapies, such as alprostadil (PGE-1). Objective: To identify the clinical profile of patients with PAOD and associated comorbidities who benefit from alprostadil as the therapy of choice. Methodology: A descriptive literature review was conducted, analyzing 15 articles from the Medline, SciELO, Latindex, LILACS, and Google Scholar databases, including publications from the past 25 years in high-impact international journals. The search used the descriptors “Peripheral Arterial Occlusive Disease,” “Alprostadil,” “Treatment,” and “Clinical Evolution,” excluding studies with methodological inconsistencies or those addressing other manifestations of atherosclerosis. Results: Alprostadil demonstrated benefits for patients with severe PAOD (stages III and IV), evidenced by reduced pain, accelerated ulcer healing, and decreased amputation rates, as observed in 7 studies. In patients with PAOD associated with Diabetes Mellitus, 4 studies indicated additional improvements. However, in patients on hemodialysis, 1 study found no significant benefits. For intermittent claudication, 2 studies reported pain reduction and increased walking distance. Discussion: The results show that alprostadil is effective in treating severe PAOD, accelerating ulcer healing and reducing amputations. Patients with Diabetes Mellitus also benefited, suggesting an additional positive response. For early-stage PAOD, alprostadil’s benefits are limited, favoring surgical treatment. In hemodialysis patients, the results were unsatisfactory, indicating the need for alternative therapeutic options. Conclusion: Alprostadil benefits patients with advanced PAOD and associated comorbidities, such as Diabetes Mellitus, but is not effective for hemodialysis patients. Further studies are needed to evaluate the use of alprostadil in early stages of PAOD and other clinical conditions.