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The Use and Impact of Cilostazol on Patients Undergoing Endovascular Peripheral Interventions.
- Source :
-
Annals of vascular surgery [Ann Vasc Surg] 2024 Jun; Vol. 103, pp. 47-57. Date of Electronic Publication: 2024 Feb 20. - Publication Year :
- 2024
-
Abstract
- Background: Cilostazol is used for the treatment of intermittent claudication. The impact of cilostazol on the outcomes of peripheral vascular interventions (PVIs) remains controversial. This study assesses the use and impact of cilostazol on patients undergoing PVI for peripheral arterial disease (PAD).<br />Methods: The Vascular Quality Initiative (VQI) database files for PVI were reviewed. Patients with PAD who underwent PVI for chronic limb threatening-ischemia or claudication were included and divided based on the use of cilostazol preoperatively. After propensity matching for patient demographics and comorbidities, the short-term and long-term outcomes of the 2 groups (preoperative cilostazol use versus no preoperative cilostazol use) were compared. The Kaplan-Meier method was used to determine outcomes.<br />Results: A total of 245,309 patients underwent PVI procedures and 6.6% (N = 16,366) were on cilostazol prior to intervention. Patients that received cilostazol were more likely to be male (62% vs 60%; P < 0.001), White (77% vs. 75%; P < 0.001), and smokers (83% vs. 77%; P < 0.001). They were less likely to have diabetes mellitus (50% vs. 56%; P < 0.001) and congestive heart failure (14% vs. 23%; P < 0.001). Patient on cilostazol were more likely to be treated for claudication (63% vs. 40%, P < 0.001), undergo prior lower extremity revascularization (55% vs. 51%, P < 0.001) and less likely to have undergone prior minor and major amputation (10% vs. 19%; P < 0.001) compared with patients who did not receive cilostazol. After 3:1 propensity matching, there were 50,265 patients included in the analysis with no differences in baseline characteristics. Patients on cilostazol were less likely to develop renal complications and more likely to be discharged home. Patients on cilostazol had significantly lower rates of long-term mortality (11.5% vs. 13.4%, P < 0.001 and major amputation (4.0% vs. 4.7%, P = 0.022). However, there were no significant differences in rates of reintervention, major adverse limb events, or patency after PVI. Amputation-free survival rates were significantly higher for patients on cilostazol, after 4 years of follow up (89% vs. 87%, P = 0.03).<br />Conclusions: Cilostazol is underutilized in the VQI database and seems to be associated with improved amputation-free survival. Cilostazol therapy should be considered in all patients with PAD who can tolerate it prior to PVI.<br /> (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Male
Female
Aged
Treatment Outcome
Time Factors
Risk Factors
Middle Aged
Retrospective Studies
Aged, 80 and over
Tetrazoles therapeutic use
Tetrazoles adverse effects
Ischemia physiopathology
Ischemia diagnosis
Ischemia mortality
Ischemia therapy
Ischemia drug therapy
Kaplan-Meier Estimate
United States
Risk Assessment
Cardiovascular Agents adverse effects
Cardiovascular Agents therapeutic use
Cilostazol therapeutic use
Cilostazol adverse effects
Peripheral Arterial Disease physiopathology
Peripheral Arterial Disease therapy
Peripheral Arterial Disease diagnosis
Peripheral Arterial Disease drug therapy
Endovascular Procedures adverse effects
Endovascular Procedures mortality
Databases, Factual
Intermittent Claudication physiopathology
Intermittent Claudication drug therapy
Intermittent Claudication diagnosis
Intermittent Claudication therapy
Amputation, Surgical
Limb Salvage
Subjects
Details
- Language :
- English
- ISSN :
- 1615-5947
- Volume :
- 103
- Database :
- MEDLINE
- Journal :
- Annals of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 38387798
- Full Text :
- https://doi.org/10.1016/j.avsg.2023.12.071