The use of cilostazol in the treatment of patients with obliterating atherosclerosis on the background of diabetes mellitus

Abstract

Introduction. Symptomatic peripheral arterial disease (intermittent claudication) is the main cause of disability and loss of mobility in patients and thus has a significant negative impact on their quality of life. Conservative treatment of these patients should be aimed at improving local blood flow, tissue metabolism and blood rheology. Cilostazol is the only drug with a Class I (Evidence A) recommendation for the treatment of intermittent claudication.Objective. Тo evaluate the clinical efficacy and safety of the use of cilostazol in patients with a combination of obliterating atherosclerosis of the arteries of the lower extremities and diabetes mellitus.Materials and methods. In 2021–2022, 102 patients were treated. Men – 78, women – 24, the average age was 62 ± 2.8 years. All patients were prescribed basic treatment of atherosclerosis of the arteries against the background of diabetes mellitus. In the first group (n = 52), cilostazol was additionally prescribed 100 mg 2 times a day. In the second group (n = 50), pentoxifylline was additionally prescribed 600 mg 2 times a day. The severity of the pain syndrome, the pain-free walking distance, the maximum walkable distance, the change in the ankle-shoulder index and partial oxygen pressure in the capillary blood of the foot tissues, the presence of negative outcomes were assessed after 1, 3, 6 months of treatment.Results and discussions. In group 1 patients, a more pronounced decrease in pain syndrome was noted compared to group 2, both in patients with IIA degree and in patients with IIB degree of lower limb ischemia according to Fontaine. The increase in pain-free walking distance and the maximum walking distance in group 1 were more significant than in group 2, starting from the 3rd month of treatment. The ankle-brachial index practically did not change, both in group 1 and in group 2. Negative outcomes of treatment after 6 months in the 1st group – 1.9%, and in the 2nd group – 8%.Conclusions. If it is impossible to revascularize the limb in patients with obliterating atherosclerosis of the arteries on the background of diabetes mellitus, the inclusion of cilostazol in the treatment regimen shows better final results than the appointment of pentoxifylline. The use of cilostazol significantly improved the quality of life and functional ability of the lower extremities in patients with intermittent claudication.

Keywords

• obliterating atherosclerosis of the arteries of the lower extremities
• diabetes mellitus
• intermittent claudication
• conservative treatment
• cilostazol
• pentoxifylline