Cilostazol and freedom from amputation after lower extremity revascularization

Area of Science:

• Vascular Surgery
• Pharmacology
• Health Outcomes Research

Background:

• Cilostazol, an antiplatelet and vasodilating agent, has limited evaluation in lower extremity revascularization (LER).
• Understanding its role in limb salvage after LER procedures is crucial for optimizing patient care.

Purpose of the Study:

• To evaluate the association between cilostazol use and limb salvage outcomes after endovascular or open surgery for LER.
• To identify specific patient subgroups that may benefit most from cilostazol therapy.

Main Methods:

• Retrospective analysis of Medicare data (2007-2008) for patients aged ≥65 undergoing LER.
• Covariates included demographics, comorbidities, and disease severity; cilostazol use was identified via drug files.
• Outcomes compared using chi-squared, Kaplan-Meier, and Cox regression analyses.

Main Results:

• Cilostazol users (8.7%) had significantly lower amputation rates at 30 days, 90 days, and 1 year compared to nonusers (14.8% vs 24.0%).
• Cox regression confirmed nonusers had higher amputation risk (HR, 1.15; P = .02) within 1 year.
• Subgroup analyses showed improved 1-year amputation-free survival for patients with renal failure and diabetes taking cilostazol.

Conclusions:

• Cilostazol use is associated with improved 1-year freedom from amputation following LER.
• Patients with renal failure and diabetes experience significant benefits from cilostazol.
• Further research is warranted to confirm these findings and explore optimal cilostazol use post-LER.