Key result
Postoperative cilostazol is linked to improved graft patency after infrainguinal autologous vein bypass.
Why the study?
The effectiveness of postoperative medication for preventing late graft failure is controversial, and whether cilostazol improves mid-term outcomes after infrainguinal autologous vein bypass for CLTI was investigated.
Does postoperative cilostazol improve mid-term graft patency and reduce major adverse limb events in patients undergoing infrainguinal autologous vein bypass for chronic limb-threatening ischemia?
Cohort (n=523)
Yes
Does postoperative cilostazol improve mid-term graft patency and reduce major adverse limb events in patients undergoing infrainguinal autologous vein bypass for chronic limb-threatening ischemia?
Postoperative cilostazol use is associated with improved mid-term assisted primary patency, secondary patency, and freedom from major adverse limb events after infrainguinal autologous vein bypass for chronic limb-threatening ischemia.
Answers are grounded in this paper and cite their sources.
May support cilostazol post-bypass in observational data; leaves open randomized confirmation before practice change.
OBJECTIVES: The effectiveness of postoperative medication for the prevention of late graft failure is controversial. We conducted the present study to investigate whether cilostazol improved the mid-term outcomes after infrainguinal autologous vein bypass for chronic limb-threatening ischemia (CLTI). METHODS: From April 1994 to March 2022, we performed 590 de novo infrainguinal bypass procedures using autologous vein grafts (AVGs) in three hospitals. The bypass grafts were classified according to the postoperative prescription of cilostazol. The loss of graft patency and major adverse limb events (MALEs) were set as endpoints. Patients who died within 30 days and grafts that lost primary patency within 30 days after surgery were excluded. Data up to 3 years were analyzed. The cumulative primary patency (PP), assisted primary patency (AP), secondary patency (SP), and freedom from MALE (ffMALE) rates were calculated by the Kaplan-Meier method and compared between the cilostazol group and the non-cilostazol group. After a propensity score matching, same statistical analyses were performed. In addition, a Cox proportional hazards regression analysis that included preoperative factors, intraoperative factors, and postoperative medications was performed to identify whether cilostazol is an independent predictor for the outcomes. RESULTS: A total of 523 AVGs met inclusion criteria. Kaplan-Meier curves showed that the cilostazol group was superior to the non-cilostazol group in all outcomes, while the cilostazol group was superior to the non-cilostazol group in AP and SP after a propensity score matching. A multivariable analysis showed that non-use of cilostazol was identified as an independent predictor for loss of AP, SP, and ffMALE. CONCLUSIONS: Cilostazol improved the mid-term outcomes after infrainguinal autologous vein bypass.
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Mii et al. (2023) conducted a cohort in Chronic limb-threatening ischemia (CLTI) (n=523). Cilostazol vs. Non-cilostazol was evaluated on Loss of graft patency and major adverse limb events (MALEs). Postoperative cilostazol use was superior to non-use for assisted primary patency and secondary patency after infrainguinal autologous vein bypass in a propensity-matched analysis.
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