ADVISABILITY OF USING CILOSTAZOL IN PATIENTS WITH CHRONIC LIMB-THREATENING ISCHEMIA

Abstract

The article presents the results of surgical and conservative treatment of patients with chronic limb-threatening ischemia (CLTI) of the lower extremities due to steno-occlusive atherosclerotic arterial lesions. The definite role of cilostazol in creating favorable conditions for the healing of trophic wounds is shown.
 Aim: to improve the results of surgical treatment of patients with CLTI, with use of surgical and conservative methods of treatment, in particular the use of the Cilostazol (Plestazol).
 Materials and methods. The research included 60 people aged 53 to 82 years with CLTI. All patients had trophic skin changes on the lower extremities (IV grade according to Fontaine classification; 5, 6 category according to Rutherford classification). The operations were performed by the open method (aorto-bifemoral bypass grafting / prosthetics, femoral-popliteal / distal bypass grafting) and X-ray endovascular method (percutaneous balloon angioplasty of the arteries of the lower extremities and stenting of the arteries). The examined patients were divided into 2 groups statistically and clinically comparable (in the main group, open operations were performed in 12 patients, endovascular interventions in 18 patients). In the comparison group - 17 patients were operated openly, endovascular – 13 patients).
 The research evaluated the microflora sown from wounds on the foot, the size of the skin defect, the rate of healing of which was assessed in the dynamics (reduction of wound area), the rate of body and changes in white blood, antibacterial drugs were prescribed according to sensitivity. During microbiological examination and culture of wounds of the lower extremities, it was found that the most common flora were gram-positive staphylococci (S. aureus, S. epidermidis). E. coli, Pr. mirabilis, Ps were also sown as accompanying flora. The area of necrosis was determined using a transparent film with a grid of squares of 1 mm². Wounds were treated topically with antiseptic and antimicrobial drugs according to the stages of the wound process without the use of hardware treatments.
 The drug was prescribed as an additional antiplatelet therapy and as a vasodilator to assess the effectiveness of cilostazol in the main group. In the comparison group, patients received antiplatelet therapy.
 Research results. A homogeneous category of patients with chronic limb-threatening ischemia, who underwent revascularization, demonstrate different rates of healing of the initial trophic ulcers and the appearance of fresh granulation tissue. The fresh granulation tissue after treatment of wounds on the foot, including after performed necrectomy in patients in the main group appeared in 6-11 days (9.7 ± 2.83, confidence interval 8.69-10.71), while the time of appearance of the newly formed granulation tissue in the comparison group was 9-16 days. The total time of wound healing in the main group averaged 70 (73.1 ± 2.05) days, in the comparison group this figure was 90 (89 ± 2.63) days.
 All patients who received the drug Cilostazol had a faster rate of healing of necrosis, which is explained, among other things, by the pro-angioproliferative properties of the drug.
 Conclusions. The use of surgical and conservative methods of treatment in particular use of cilostazol (plestazol) in patients with chronic limb-threatening ischemia, can shorten the healing time of wounds.