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

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.