Cilostazol After Endovascular Therapy for Femoropopliteal Peripheral Arterial Disease: A Systematic Review and Meta-analysis

Authors

Christian D. Cerecedo, The University of Texas Rio Grande Valley
Aaron Silva, The University of Texas Rio Grande Valley
Valentine S. Alia, The University of Texas Rio Grande Valley
Ana Vargas, The University of Texas Rio Grande Valley
Alejandro Garza, Doctor's Hospital at Renaissance
Omar El Shazly
Alejandro J. Candil, The University of Texas Rio Grande Valley

Document Type

Article

Publication Date

3-2025

Abstract

Background

Endovascular therapy (ET) outcomes for femoropopliteal peripheral arterial disease (FP-PAD) remain suboptimal. Cilostazol therapy may improve patency rates and decrease major adverse limb events after ET for FP-PAD. Our goal was to analyze published studies evaluating the use of cilostazol after ET for FP-PAD.

Methods

We searched MEDLINE, EMBASE, and CENTRAL for randomized and observational studies (OSs) evaluating cilostazol therapy after ET for FP-PAD. We only included OSs adjusting for confounding variables. We analyzed observational and randomized studies separately and explored heterogeneity by estimating an I2 statistic. A fixed-effects model was chosen if the I2 statistic was low. If the two-sided probability of observing the difference between groups under a true null hypothesis was Results We screened 2171 studies and included 26 papers in our analysis (5 randomized controlled trials and 21 OSs). All randomized studies were open label. In randomized studies, the odds of restenosis were lower in patients treated with cilostazol (pooled odds ratio, 0.28; 95% confidence interval [CI], 0.18-0.43; P < .01; I2 = 0%). The odds of target lesion revascularization (TLR) were also lower in patients treated with cilostazol (pooled odds ratio, 0.35; 95% CI, 0.22-0.65; P < .01; I2 = 0%). In OSs, we also identified associations between peri-interventional treatment with cilostazol and lower rates of restenosis (pooled hazard ratio [pHR], 0.57; 95% CI, 0.51-0.65; P < .01; I2 = 34%), TLR (pHR, 0.53; 95% CI, 0.36-0.79; P < .01; I2 = 0%), and amputation (pHR, 0.54; 95% CI, 0.32-0.90; P= .02; I2 = 30%).

Conclusions

In randomized open-label studies, peri-interventional treatment with cilostazol after ET for FP-PAD decreased the odds of restenosis and TLR (Level 1A). Similarly, in OSs that adjusted for confounding, peri-interventional cilostazol therapy was associated with lower rates of restenosis, TLR, and amputation (Level 2A).

Comments

Original published version available at https://doi.org/10.1016/j.jvs.2024.08.032

Recommended Citation

Cerecedo, C. D., Silva, A., Alia, V. S., Vargas, A., Garza, A., El Shazly, O., & Candil, A. J. (2025). Cilostazol after endovascular therapy for femoropopliteal peripheral arterial disease: A systematic review and meta-analysis. Journal of vascular surgery, 81(3), 767–774.e7. https://doi.org/10.1016/j.jvs.2024.08.032

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Publication Title

Journal of vascular surgery

DOI

https://doi.org/10.1016/j.jvs.2024.08.032

Academic Level

faculty

Mentor/PI Department

Surgery