Postoperative Benefits of Cilostazol on Patients Undergoing Intervention for Chronic Limb Ischemia

Although prior studies have shown the short-term benefits of cilostazol on claudicant patients who underwent iliac or femoropopliteal revascularization procedures, the literature on patients with chronic limb ischemia (CLI) is limited. Recent molecular analysis suggests that the possible cardiovascular benefits of cilostazol are mediated through a nitric oxide pathway. As such, we hypothesized that cilostazol use in patients undergoing intervention for CLI would have reduced major adverse limb events, reinterventions, and improved long-term survival. Vascular Quality Initiative (5/2012 to 10/2021) patients undergoing aortoiliac/femoropopliteal revascularizations for CLI were included. Patients were stratified either on cilostazol or no cilostazol, and all patients with chronic heart failure were excluded for known contraindications. Incomplete covariate information was imputed. The groups’ clinical characteristics were balanced using Inverse probability weighting. The primary endpoint was all-cause mortality. Secondary endpoints included perioperative major adverse limb events (stenosis/occlusion, thrombosis, amputation, and dissection), and 1-year major adverse limb events (occlusion, amputation, revascularization). There were 1824 cilostazol and 26,029 no cilostazol patients included in the final analysis (Fig). The cilostazol group had a lower incidence of perioperative major adverse limb events during admission (P < .001: 3.5% vs 4.8%) and adjusted Kaplan-Meier analysis showed a significant 6-year survival difference (P < .001: 85% cilostazol vs 79% no cilostazol). In the adjusted regression model, patients taking cilostazole preoperatively demonstrated lower odds of major adverse limb events during hospitalization (odds ratio, 0.7; 95% confidence interval, 0.6-0.9; P < .05) and lower risk of 6-year mortality (hazard ratio, 0.7; 95% confidence interval, 0.6-0.9; P < .05 at 6 years). There was no significant difference in 1-year major adverse limb events or perioperative mortality. A preoperative regimen of cilostazol before aortoiliac/femoropopliteal revascularizations in patients with CLI is associated with better long-term mortality, thus expanding the literature-endorsed recommendation to provide cilostazol before peripheral vascular procedures in this cohort should be considered. Impact of cilostazol on long-term limb salvage and quality of life in patients with CLI requires further study.