How to measure the response to PGE-1 in non-reconstructable Peripheral arterial disease

In Non-reconstructable, leg peripheral arterial disease, the peripheral pulses at the ankle are generally not palpable and some times even doppler signals are not audible. Then it becomes a dilemma! in our minds about the assessment methods to measure of the response to treatment with Injections of PGE-1. We follow these patients based on the improvement of clinical symptoms such as pain, ulcer healing, 6 minute walking test, increase in the ankle pressures with portable doppler machine, intensity of the audible sound from the Dorsalis Pedis, Posterior tibial arteries. The ankle pressure may not improve immediately,  but slow and steady progress in the relief of symptoms is considered as positive response to the medication. The rest pain is relieved in majority of the patients. ulcers start healing in 6 weeks to 3 months. Mean while we should ask patients to refrain from smoking.

Prostaglandin E₁ (PGE1), also known as alprostadil, is a naturally occurring prostaglandin which is used as a medication.^[1] In infants with congenital heart defects, it is delivered by slow injection into a vein to open the ductus arteriosus until surgery can be carried out.^[2] By injection into the penis or placement in the urethra, it is used to treat erectile dysfunction.^[3] Common side effects when given to babies include decreased breathing, fever, and low blood pressure.^[1] When used for erectile dysfunction side effects may include penile pain, bleeding at the site of injection, and prolonged erection (priapism).^[1] Prostaglandin E₁ is in the vasodilator family of medications.^[1] It works by opening blood vessels and relaxing smooth muscle.^[1] Prostaglandin E₁ was isolated in 1957 and approved for medical use in the United States in 1981.^[1][4] It is on the World Health Organization's List of Essential Medicines.^[5]

1.  "Alprostadil". The American Society of Health-System Pharmacists. Archived from the original on 16 January 2017. Retrieved 8 January 2017.
2. ^ Northern Neonatal Network (208). Neonatal Formulary: Drug Use in Pregnancy and the First Year of Life (5 ed.). John Wiley & Sons. p. 2010. ISBN 9780470750353. Archived from the original on 13 January 2017.
3. ^ British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 569. ISBN 9780857111562.
4. ^ Sneader, Walter (2005). Drug Discovery: A History. John Wiley & Sons. p. 185. ISBN 9780470015520. Archived from the original on 13 January 2017.
5. ^ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.