Pentoxifylline treatment of moderate to severe chronic occlusive arterial disease.

A pilot study of the effects of pentoxifylline in 19 patients with moderate to severe chronic occlusive arterial disease (COAD) is described. The severity of disease was assessed by the degree of limitation in the walking distance on the flat surface (less than 100 m), the absence of peripheral pulses on palpation, the diminished Doppler tibial/brachial pressure (the ischemic index) at rest, and by contrast arteriography, when available. After a 2-week washout phase, all subjects received pentoxifylline (1200 mg/day) in an open-label manner for a total of 12 weeks. Twelve of the nineteen patients showed a definite increase in exercise tolerance by the end of the study, with a concomitant reduction in ischemic symptoms. All except 3 patients felt they had derived benefit from the medication. In contrast to the clear improvements in walking distance and symptoms, only small effects on noninvasive vascular laboratory measurements were noted. Platelet aggregation, induced by ADP, epinephrine, and collagen, gradually decreased over the study period. Pentoxifylline appears to be useful in the medical management of patients with moderate to severe chronic occlusive arterial disease; future controlled trials in such patients are now justified.