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Pre-operative Cilostazol in Patients with Chronic Limb Threatening Ischaemia Associated with Improved Survival after

Alexandra A Sansosti1, Beatrix Choi1, Jose Munoz2

  • 1Division of Vascular Surgery, Department of Surgery, Columbia University Medical Centre, New York, NY, USA.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|August 22, 2025
PubMed

Insights

Pre-operative cilostazol significantly improves long-term survival and reduces amputation rates for patients with chronic limb-threatening ischemia undergoing endovascular therapy. This finding supports cilostazol

Area of Science:

  • Vascular Surgery
  • Pharmacological Interventions
  • Patient Outcomes

Background:

  • Chronic limb-threatening ischemia (CLTI) poses significant risks.
  • Endovascular therapy (EVT) is a key treatment modality for CLTI.
  • Optimizing pre-operative strategies is crucial for improving patient outcomes.

Purpose of the Study:

  • To evaluate the impact of pre-operative cilostazol on long-term survival.
  • To assess peri-operative outcomes in CLTI patients undergoing EVT.
  • To determine if cilostazol influences amputation and complication rates.

Main Methods:

  • Retrospective cohort study using the Vascular Quality Initiative registry.
  • Propensity score adjustment for patient cohorts (cilostazol vs. no cilostazol).
  • Analysis of 5-year all-cause mortality, peri-operative amputation, cardiac complications, and thrombotic events.

Main Results:

  • Pre-operative cilostazol use was associated with significantly higher 5-year survival (HR 0.56).
  • The cilostazol group showed significantly lower rates of peri-operative amputation (OR 0.69).
  • No significant differences were observed in other peri-operative outcomes.

Conclusions:

  • Pre-operative cilostazol is linked to improved long-term survival in CLTI patients undergoing EVT.
  • Cilostazol use is associated with reduced peri-operative amputation rates.
  • Further prospective studies are warranted to confirm cilostazol's benefit in this high-risk population.
Abstract

Keywords:
CLTIChronic limb threatening ischaemiaCilostazolEndovascular revascularisationPeripheral arterial occlusive diseasePre-operative medical optimisation

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