SLR - June 2021 - Joslin L. Seidel

Outcomes with Cilostazol after Endovascular Therapy of Peripheral Artery Disease

Reference: Megaly M, Abraham B, Saad M, Mekaiel A, Soukas P, Banerjee S, Shishehbor MH. Outcomes with Cilostazol after Endovascular Therapy of Peripheral Artery Disease. Vasc Med. 2019 Aug;24(4):313-323. doi: 10.1177/1358863X19838327. Epub 2019 Apr 26. PubMed PMID: 31023156.

Scientific Literature Review 

Reviewed By: Joslin L. Seidel, DPM
Residency Program: Cambridge Health Alliance, Cambridge, MA

Podiatric Relevance: The rates of restenosis after endovascular therapy (EVT) remain high, with restenosis being associated with worse clinical outcomes including critical limb ischemia (CLI), limb loss, and mortality. Considering these high restenosis rates, a meta-analysis was conducted to examine the outcomes of supplemental cilostazol after peripheral endovascular interventions for peripheral arterial disease.

Methods: Comprehensive meta-analysis reporting the outcomes of cilostazol after EVT from January 2000 through November 2018 with the outcomes of interest including primary patency, major adverse limb events (MALE), target lesion revascularization (TLR), and major amputation. This met analysis included eight studies (three randomized controlled trials and five observational studies) totaling 3846 patients (4713 lesions) with a mean follow-up duration of 12.5 ± 5 months.

Results: The use of cilostazol was associated with higher primary patency, lower risk of TLR, and lower risk of major amputation. Cilostazol in RCTs was linked with significantly higher odds of primary patency compared with observational studies. Further analysis was conducted, which revealed a higher primary patency regardless of the use of anticoagulants (such as warfarin).

Conclusions: This meta-analysis demonstrated the use of cilostazol after EVT of femoropopliteal and iliac lesions is associated with improved primary patency and lower risk of major amputation and TLR. This favorable effect of cilostazol was independent of the use of warfarin. Peripheral arterial disease is a condition effecting a significant portion of our patient population with many of them requiring vascular intervention. Even though as podiatrists we do not manage such pharmacological therapies it is important to be educated on their potential use.

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