Literature review and meta-analysis of the efficacy of cilostazol on limb salvage rates after infrainguinal endovascular and open revascularization

Desai, Kshitij; Han, Bum Soo; Kuziez, Laila; Yan, Yan; Zayed, Mohamed A.

doi:10.1016/j.jvs.2020.08.125

Cited by 25 publications

(9 citation statements)

References 39 publications

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“…Cilostazol, a phosphodiesterase III inhibitor, is known to significantly improve walking distances in patients with stable, moderate to severe intermittent claudication (26,27). Cilostazol, which is used as an effective treatment option for symptomatic improvement and increasing walking distance in peripheral artery patients with intermittent claudication, has also been observed in our study.…”

Section: Discussionsupporting

confidence: 75%

Comparison of sympathectomy and cilostazol treatment results in non-revascularized critical leg ischemia

Gültekin

Bolat

Gemalmaz

2021

Journal of Health Sciences and Medicine

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The aim of this retrospective study is to compare the efficacy of sympathectomy and cilostazol therapy in critical limb ischemia that cannot be revascularized. Material and Method:This study was retrospectively conducted on 30 patients who underwent lumbar sympathectomy (Group 1) and received cilotazol treatment (Group 2) between January 2017 and August 2020. Demographic data, comorbidity, complications, wound healing, walking distance and pain scale records of the patients were determined by examining the hospital registry system and statistical analysis was performed. Results: In the study, no significant difference was found between the two groups in terms of walking distance and ischemic pain in the statistical analysis of the data before treatment, at the 3rd, 6th, 12th and 24th months (p>0.05). However, a statistically significant difference was found between the pre-treatment data and the data at the 3rd, 6th, 12th and 24th months in both Group 1 and Group 2 in terms of walking distance and ischemic pain (p<0.001 ). In the time periods followed in both groups, it was observed that there was an increase in walking distance and a decrease in ischemic pain. Conclusion:Cilostazol treatment may be preferred as a good alternative treatment method compared to lumbar sympathectomy in critical leg ischemia.

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Section: Discussionsupporting

confidence: 75%

Comparison of sympathectomy and cilostazol treatment results in non-revascularized critical leg ischemia

Gültekin

Bolat

Gemalmaz

2021

Journal of Health Sciences and Medicine

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“…A recent review indicated that, over 2 years, cilostazol favored amputation-free survival (HR, 0.79), limb-salvage rate (HR, 0.42), decreased repeat revascularization (RR, 0.44), and restenosis (RR, 0.68). 270 Cilostazol also increased freedom from revascularization (RR, 1.35) with no difference in all-cause mortality. Finally, another recent review of 16 RCTs (N = 3972) comparing cilostazol with placebo, of which 5 studies also compared cilostazol with pentoxifylline, showed that participants taking cilostazol had a higher initial claudication distance compared with those taking placebo (mean difference, 26.49 m), and a higher absolute claudication distance (39.57 m) with a likely indication for improved quality of life in the cilostazol groups.…”

Section: Meta-analyses/reviewsmentioning

confidence: 94%

“…A recent review indicated that, over 2 years, cilostazol favored amputation‐free survival (HR, 0.79), limb‐salvage rate (HR, 0.42), decreased repeat revascularization (RR, 0.44), and restenosis (RR, 0.68) 270 . Cilostazol also increased freedom from revascularization (RR, 1.35) with no difference in all‐cause mortality.…”

Section: Peripheral Artery Diseasementioning

confidence: 99%

Update on Cilostazol: A Critical Review of Its Antithrombotic and Cardiovascular Actions and Its Clinical Applications

Manolis

Manolis²,

Melita

et al. 2021

The Journal of Clinical Pharma

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Cilostazol, a phosphodiesterase III inhibitor, has vasodilating and antiplatelet properties with a low rate of bleeding complications. It has been used over the past 25 years for improving intermittent claudication in patients with peripheral artery disease (PAD). Cilostazol also has demonstrated efficacy in patients undergoing percutaneous revascularization procedures for both PAD and coronary artery disease. In addition to its antithrombotic and vasodilating actions, cilostazol also inhibits vascular smooth muscle cell proliferation via phosphodiesterase III inhibition, thus mitigating restenosis. Accumulated evidence has shown that cilostazol, due to its "pleiotropic" effects, is a useful, albeit underutilized, agent for both coronary artery disease and PAD. It is also potentially useful after ischemic stroke and is an alternative in those who are allergic or intolerant to classical antithrombotic agents (eg, aspirin or clopidogrel). These issues are herein reviewed together with the pharmacology and pharmacodynamics of cilostazol. Large studies and meta-analyses are presented and evaluated. Current guidelines are also discussed, and the spectrum of cilostazol's actions and therapeutic applications are illustrated.

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“…Az eredmények alapján hosszú távú cilosztazolkezelés mellett szignifikánsan csökkent mind az amputációk száma, mind a mortalitás [57]. Egy 10 vizsgálat eredményét (3136 beteg, 1999 és 2020 közötti időszak) összegző metaanalízis szerint alsó végtagi endovascularis vagy nyílt érsebészeti beavatkozást követően az amputációmentes túlélés, az amputációk, az ismételt revascularisatio szükségessége, valamint a restenosis vonatkozásában a cilosztazolkezelés jótékonynak mutatkozott [58].…”

Section: A Thrombocytaaggregáció-gátló Monoterápia éS a Cilosztazolke...unclassified

Az alsó végtagi endovascularis verőér-beavatkozások során alkalmazott antithromboticus, antikoaguláns terápia szempontjai

Szabó

Dósa

Csobay-Novák

et al. 2022

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Összefoglaló. A népesség öregedése, a meghatározó cardiovascularis rizikótényezők – mint a cukorbetegség – egyre nagyobb arányú előfordulása, a csökkenő akut cardiovascularis halálozás az alsó végtagi verőérszűkület növekvő megjelenésével jár. Ezzel együtt szaporodnak a beavatkozást igénylő, jelentős életminőség-romlást, illetve végtag-veszélyeztetettséget okozó, súlyosabb esetek. Ilyenkor az alsó végtagi revascularisatio szüksége merül fel, ami az utóbbi évtizedben az endovascularis beavatkozások számának növekedéséhez vezetett. A beavatkozások technikai sikere mellett újabb szűkületek, elzáródások veszélyével kell számolni. Ennek hátterében az atherosclerosis progressziója mellett a beavatkozáshoz köthető, kontrollált érfalsérülés indukálta vascularis remodelling (neointima-hyperplasia), valamint thromboticus tényezők állnak. Az ér-nyitvamaradás hosszú távú biztosításának feltétele a fenti folyamatok megelőzésére alkalmazott optimális gyógyszeres kezelés. Ennek biztosítása elengedhetetlen a beavatkozást megelőzően, periprocedurálisan, majd az érintett betegkör hosszú távú gondozása során. A gyógyszeres terápiás lehetőségek közül az antithromboticus, antikoaguláns terápiának kiemelt jelentősége van. Az ezen hatású gyógyszerek alkalmazását igen nehézzé teszi (i) a thromboticus elzáródás kiújulása és a potenciális vérzés közötti dinamikusan változó egyensúly bizonytalansága, (ii) az egyéb társbetegségek kapcsán felmerülő terápiás szempontok egyidejű érvényesítése, valamint (iii) a napi ellátásban támpontot adó tudományos bizonyítékok relatív hiánya. Az összefoglaló tanulmány a fenti gyógyszerterápiás terület legújabb eredményeit kísérli meg elemezni. Orv Hetil. 2022; 163(3): 98–108. Summary. The aging of the population, the increasing prevalence of important risk factors of atherosclerosis, like diabetes, and the declining mortality of acute cardiovascular conditions lead to increased peripheral arterial disease incidence. At the same time, cases showing a severe decline in quality of life or danger of limb loss get more prevalent that demands vascular interventions. In such cases, revascularization is recommended, and consequently, in the last decade, an expansion in endovascular procedures can be seen. Considering these procedures, besides a technical success, the risk of new stenosis or occlusion may be imminent. This may be accounted for the progression of atherosclerosis and the controlled vascular injury caused by the procedure itself that induces vascular remodeling (neointima hyperplasia) and thrombotic hyperactivity. The long-term vascular patency is closely associated with the success of an optimal medical treatment strategy. Its effect is considered essential prior to the endovascular procedure, perioperatively, and in the phase of long-term follow-up of the affected patients. In this scenario, antithrombotic and anticoagulant therapy regimes bear particular relevance. The use of this kind of drugs is challenged by (i) the uncertainty of dynamic changes of balance between the thrombotic reocclusion and the risk of bleeding, (ii) the interplay of treatment strategy related to concomitant diseases, (iii) the relative lack of high-level scientific pieces of evidence guiding daily routine. The narrative review makes an effort to provide new findings and an analysis of this therapeutic field. Orv Hetil. 2022; 163(3): 98–108.

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Literature review and meta-analysis of the efficacy of cilostazol on limb salvage rates after infrainguinal endovascular and open revascularization

Cited by 25 publications

References 39 publications

Comparison of sympathectomy and cilostazol treatment results in non-revascularized critical leg ischemia

Comparison of sympathectomy and cilostazol treatment results in non-revascularized critical leg ischemia

Update on Cilostazol: A Critical Review of Its Antithrombotic and Cardiovascular Actions and Its Clinical Applications

Az alsó végtagi endovascularis verőér-beavatkozások során alkalmazott antithromboticus, antikoaguláns terápia szempontjai

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