Efficacy Of Prostaglandin E2 ( PGE2) Infusion In The Immediate Peri-Operative Period In Open Abdominal Aortic Aneurysm Repair

Objectives: Prostacyclin analogues, compelling vasodilators and inhibitors of platelet activation, have conventionally been exploited in pulmonary hypertension and off label for revascularisation in critical limb ischaemia. We aim to gauge the effect of 72 hour PGE2 infusion on systemic ischaemia post open AAA surgery.
Methods: From 2002-2005, 88 patients (29 juxtarenal, 13 suprarenal, 46 infrarenal) who had elective open AAA repair were included with mean aneurysm diameter of 6.7cm; Male: female ratio 2.5:1 and mean age 72.2years.
45 patients received PGE2 infusion for 72 hours immediately post operatively. 43 patients did not. No statistically significant difference was seen in age, sex, risk factors or aneurysm diameter between groups. Patients were scrutinized for signs of renal, cardiac, pulmonary or bowel ischaemia and peri-operative morbidity.
Results: 30-day mortality was abridged in the PGE2 group (2% vs 7%,p=0.294). There was a significant increase in ventilation requirements (p=0.0048), pulmonary complications (p=0.0019) and myocardial ischaemia rates (p=0.0446) in patients not receiving PGE2. No Peripheral trashing was noted in the PGE2 group compared with 5 patients (11.6%) in the non PGE2 group (p=0.0219)
Non-PGE2 patients had significantly increased rate of bowel complications (18.6%vs.4.4%, p=0.049) and higher rates of acute renal failure (25.6% vs. 13.3% p=0.072) and renal dialysis (18.6% vs. 8.9%, p=0.216). ICU stay was significantly reduced in patients receiving PGE2 (6.3 vs.13.2 days, p<0.05)
Conclusions: PGE2 infusion for 72 hours after open AAA repair is associated with enhanced systemic perfusion, reduced peri-operative morbidity and superior survival. We believe PGE2 is cardio-renal and splanchinic pulmonary protective.