Abstract 10178: Impact of Cilostazol After Endovascular Treatment in Patients with Critical Limb Ischemia for Infrainguinal Disease
Background: It has been reported that cilostazol reduced restenosis and repeat revascularization after endovascular therapy (EVT) in claudicant patients with femoropopliteal lesion. However, little is known about the efficacy of cilostazol in patients with critical limb ischemia (CLI). Therefore, we investigated whether cilostazol would improve outcomes in patients with CLI.
Method: From January 2004 to December 2009, 618 patients (72.4 ± 7.3 yrs and 30.8% female, 356 cilostazol-treated patients) who underwent EVT with CLI for de novo infrainguinal lesions were identified retrospectively and analyzed. The primary outcome measure was amputation-free survival (AFS), and the secondary outcome measures were overall survival, limb salvage rate, freedom from repeat revascularization and freedom from surgical conversion. The mean follow-up period was 21 ± 14 months.
Result: AFS and limb salvage rate were significantly higher in the cilostazol-treated group (47.7 vs. 32.7% at 5-year, P<0.01, 86.6vs. 75.3% at 5-year, P<0.01, respectively). However, there was no significant difference in overall survival and freedom from repeat revascularization between the two groups (43.9 vs. 46.0% at 5-year, P=0.24, 39.9 vs. 31.8% at 5-year, P=0.21, respectively). Freedom from surgical conversion was significantly higher in the cilostazol-treated group (91.0 vs. 81.2% at 5-year, P<0.01). After correcting all endpoints with baseline variables, cilostazol was found to be effective for prevention of AFS (Hazard ratio [HR] 0.67, 95% confidential interval [CI] 0.49 to 0.91, adjusted P=0.01) and limb salvage rate (HR 0.42, 95%CI 0.25 to 0.69, adjusted P<0.01). There was no significant difference in overall survival, repeat revascularization and surgical conversion between the groups.
Conclusion: Cilostazol might improve AFS and limb salvage rate after EVT in patients with CLI for infrainguinal disease
- © 2011 by American Heart Association, Inc.