School of Medicine Publications and Presentations

Document Type

Article

Publication Date

8-2024

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 is 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 evaluating cilostazol therapy after ET for FP-PAD. We only included observational studies 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 less than 5%, we considered this difference statistically significant.

Results: We screened 2,171 studies and included 26 papers in our analysis (5 randomized and 21 observational studies). All randomized studies were open label. In randomized studies, the odds of restenosis were lower in patients treated with cilostazol (pooled odds ratio (pOR) = 0.28, 95% confidence interval (CI) 0.18 to 0.43, p < 0.01, I2 = 0%). The odds of target lesion revascularization (TLR) were also lower in patients treated with cilostazol (pOR = 0.35, 95% CI 0.22 to 0.65, p < 0.01, I2 = 0%). In observational studies, 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 to 0.65, p

Conclusions: In randomized open label studies, peri-interventional treatment with cilostazol after ET for FP-PAD lowered the odds of restenosis and TLR (Level 1A). Similarly, in observational studies 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

Publication Title

Journal of vascular surgery

DOI

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

Academic Level

faculty

Mentor/PI Department

Surgery

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Available for download on Friday, August 01, 2025

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