A durable limb salvage and functional recovery after prolonged prostaglandin E1 therapy following femoro-popliteal bypass graft thrombosis: a one-year follow-up case report

Shoaeb Imtiaz Alam; Istiaq Ahmed; Manjurul Hasan; Mufrid Kashem; M. Zahin Arefin; Sonia Anjum; Kazi Al-Hosne Jamil

doi:10.18203/2349-2902.isj20263862

Authors

Shoaeb Imtiaz Alam Department of Vascular Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh
Istiaq Ahmed Department of Cardiac Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh
Manjurul Hasan Department of Vascular Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh
Mufrid Kashem Department of Vascular Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh
M. Zahin Arefin Department of Vascular Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh
Sonia Anjum Department of Vascular Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh
Kazi Al-Hosne Jamil Department of Cardiac Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-2902.isj20263862

Keywords:

Prostaglandin E1, Femoropopliteal bypass, Graft thrombosis, Chronic limb-threatening ischemia, Collateral circulation, Limb salvage

Abstract

Infrainguinal bypass graft thrombosis can cause recurrent limb ischemia, tissue loss, and major amputation. A 65-year-old man with diabetes, hypertension, and previous cigarette smoking developed complete thrombosis of a Dacron femoropopliteal bypass graft six months after surgery. Pharmacogenetic testing identified a CYP2C19 intermediate-metabolizer phenotype associated with reduced clopidogrel responsiveness. Clopidogrel was discontinued, while aspirin and rivaroxaban were continued, and intravenous prostaglandin E1 (PGE1; alprostadil) therapy was initiated. Following three previously reported cycles, he completed six total cycles, each administered over three consecutive days at approximately four-week intervals. At one-year follow-up after treatment completion, he remained free of ischemic pain, ulceration, gangrene, and tissue loss, avoiding major amputation and repeat revascularization. He could walk more than 200 m and had Rutherford category 0 status. Follow-up computed tomography angiography demonstrated collateral vessels from the deep femoral circulation. This case highlights sustained limb preservation following prolonged PGE1 therapy despite graft thrombosis.

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