Cilostazol after endovascular therapy for femoropopliteal peripheral arterial disease: A systematic review and meta-analysis

Christian D Cerecedo; Aaron Silva; Valentine S Alia; Ana Vargas; Alejandro Garza; Omar El Shazly; Alejandro J Candil

doi:10.1016/j.jvs.2024.08.032

Cilostazol after endovascular therapy for femoropopliteal peripheral arterial disease: A systematic review and meta-analysis

J Vasc Surg. 2024 Aug 27:S0741-5214(24)01786-5. doi: 10.1016/j.jvs.2024.08.032. Online ahead of print.

Authors

Christian D Cerecedo¹, Aaron Silva², Valentine S Alia², Ana Vargas², Alejandro Garza³, Omar El Shazly⁴, Alejandro J Candil²

Affiliations

¹ Department of Surgery, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX. Electronic address: christian.cerecedolopez@utrgv.edu.
² Department of Surgery, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX.
³ Department of Surgery, Doctor's Hospital at Renaissance, Edinburg, TX.
⁴ Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA.

PMID: 39208919
DOI: 10.1016/j.jvs.2024.08.032

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 <5%, we considered this difference statistically significant.

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).

Keywords: Cilostazol; Endovascular; Femoropopliteal; Neointimal hyperplasia; Peripheral arterial disease.

Publication types

Review