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UDC 616.137.83/.93-005.4-085.27

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

V.A. Prasol¹, K.V. Miasoiedov², V.V. Shaprynskyi³

1State Institution «Institute of General and Emergency Surgery named after V.T. Zaitsev NAMNU», Kharkiv, Ukraine; ORCID ID: 0000-0002-0556-6981, e-mail: [email protected];

2Kharkiv National Medical University, Kharkiv, Ukraine; ORCID ID: 0000-0002-3878-7713, e-mail: [email protected];

3State Institution of Science “Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department, Kyiv, Ukraine, ORCID ID: 0000-0002-1437-7410,

e-mail: [email protected]

Abstract. The article presents the results of surgicaland conservative treatment of patients withchroniclimb-threatening ischemia (CLTI) of the lower extremitiesdue to steno-occlusiveatherosclerotic arterial lesions.The definite role of cilostazol in creating favorable conditionsfor the healing of trophic wounds is shown.

Aim: to improve the results of surgical treatmentof patients with CLTI, with use of surgical andconservativemethods of treatment, in particular the use of theCilostazol (Plestazol).

Materials and methods. The research included60 people aged 53 to 82 years with CLTI. Allpatientshad trophic skin changes on the lower extremities (IVgrade according to Fontaineclassification; 5, 6 categoryaccording to Rutherford classification). The operationswere performedby the open method (aorto-bifemoralbypass grafting / prosthetics, femoral-popliteal / distalbypass grafting) and X-ray endovascular method (percutaneousballoon angioplasty of the arteriesof the lowerextremities and stenting of the arteries). The examinedpatients were divided into 2 groups statistically and clinicallycomparable (in the main group, open operationswere performed in12 patients, endovascular interventionsin 18 patients). In the comparison group - 17 patientswere operated openly, endovascular – 13 patients).

The research evaluated the microflora sownfrom wounds on the foot, the size of the skin defect,therate of healing of which was assessed in the dynamics(reduction of wound area), the rate ofbody and changesin white blood, antibacterial drugs were prescribed accordingto sensitivity.During microbiological examinationand culture of wounds of the lower extremities, itwas found thatthe most common flora were grampositivestaphylococci (S. aureus, S. epidermidis). E. coli,Pr.mirabilis, Ps were also sown as accompanying flora.The area of necrosis was determined using atransparentfilm with a grid of squares of 1 mm². Wounds were treatedtopically with antiseptic andantimicrobial drugs accordingto the stages of the wound process without theuse of hardwaretreatments.

The drug was prescribed as an additional antiplatelettherapy and as a vasodilator to assess theeffectivenessof cilostazol in the main group. In the comparisongroup, patients received antiplatelettherapy.

Research results. A homogeneous category ofpatients with chronic limb-threatening ischemia,whounderwent revascularization, demonstrate different ratesof healing of the initial trophic ulcersand the appearanceof fresh granulation tissue. The fresh granulation tissueafter treatment ofwounds on the foot, including afterperformed necrectomy in patients in the main group appearedin6-11 days (9.7 ± 2.83, confidence interval 8.69-10.71), while the time of appearance of the newlyformedgranulation tissue in the comparison group was 9-16days. The total time of wound healingin the main groupaveraged 70 (73.1 ± 2.05) days, in the comparison groupthis figure was 90 (89 ±2.63) days.

All patients who received the drug Cilostazolhad a faster rate of healing of necrosis, which isexplained,among other things, by the pro-angioproliferativeproperties of the drug.

Conclusions. The use of surgical and conservativemethods of treatment in particular use ofcilostazol(plestazol) in patients with chronic limb-threatening ischemia,can shorten the healingtime of wounds.

Keywords: chronic limb-threatening ischemia,cilostazol, plestazole.