The effect of cilostazol on late outcomes after endovascular treatment for occlusive femoropopliteal disease

George Galyfos; Alexandros Chamzin; Konstantinos Saliaris; Panagiotis Theodorou; Kyriaki Konstantinou; Frangiska Sigala; Konstantinos Filis

doi:10.1016/j.jvs.2024.01.010

The effect of cilostazol on late outcomes after endovascular treatment for occlusive femoropopliteal disease

J Vasc Surg. 2024 Jan 11:S0741-5214(24)00068-5. doi: 10.1016/j.jvs.2024.01.010. Online ahead of print.

Authors

George Galyfos¹, Alexandros Chamzin², Konstantinos Saliaris², Panagiotis Theodorou², Kyriaki Konstantinou², Frangiska Sigala², Konstantinos Filis²

Affiliations

¹ Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece. Electronic address: georgegalyfos@hotmail.com.
² Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece.

PMID: 38215952
DOI: 10.1016/j.jvs.2024.01.010

Abstract

Objective: Restenosis and late occlusion remain a significant problem for endovascular treatment of peripheral artery disease. This meta-analysis aims to evaluate the effect of cilostazol on late outcomes after endovascular repair of occlusive femoropopliteal disease.

Methods: A systematic literature review was conducted conforming to established criteria to identify articles published up to September 2023 evaluating late outcomes after endovascular treatment for atherosclerotic femoropopliteal disease. Eligible studies should compare outcomes between patients treated with cilostazol and patients not treated with cilostazol. Both prospective and retrospective studies were eligible. Late outcomes included primary patency (PP), restenosis, target lesion revascularization (TLR), and major amputation during follow-up.

Results: Overall, 10 clinical studies were identified for analysis including 4721 patients (1831 with cilostazol vs 2890 without cilostazol) that were treated for 5703 lesions (2235 with cilostazol vs 3468 without cilostazol). All studies were performed in Japan. Mean follow-up was 24.1 ± 12.5 months. Cilostazol was associated with a lower risk for restenosis (pooled odds ratio [OR], 0.503; 95% confidence interval [CI], 0.383-0.660; P < .0001). However, no association was found between cilostazol and TLR (pooled OR, 0.918; 95% CI, 0.300-2.812; P = .881) as well as major amputation (pooled OR, 1.512; 95% CI, 0.734-3.116; P = .263). Regarding primary patency, cilostazol was associated with a higher 12-month PP (OR, 3.047; 95% CI, 1.168-7.946; P = .023), and a higher 36-month PP (OR, 1.616; 95% CI, 1.412-1.850; P < .0001). No association was found between cilostazol and mortality during follow-up (pooled OR, .755; 95% CI, 0.293-1.946; P = .561).

Conclusions: Cilostazol seems to have a positive effect on 1- to 3-year PP and restenosis rates among patients treated endovascularly for atherosclerotic femoropopliteal disease. A positive effect on TLR and amputation risk was not verified in this review.

Keywords: Cilostazol; Endovascular therapy; Femoropopliteal; Late outcomes; Restenosis.

Publication types

Review