Abstract. Background. The neuroischemic form of diabetic foot is characterized by combined damage to peripheral vessels and nerves, leading to chronic ulcers, pain syndrome, and a high risk of amputations. The search for additional methods to improve peripheral perfusion remains relevant. Cilostazol, a phosphodiesterase III inhibitor with vasodilatory and antiplatelet properties, has the potential to improve microcirculation and the course of neuropathy in diabetes mellitus. The purpose of the study was to evaluate the clinical efficacy of adding cilostazol to standard therapy in patients with neuroischemic form of diabetic foot syndrome, in particular the effect on pain syndrome, amputation rate, and risk of gastrointestinal bleeding. Materials and methods. An open randomized study was conducted involving 72 patients with type 2 diabetes mellitus and the neuroischemic form of diabetic foot. The study group (n = 38) received cilostazol 100 mg/day in addition to standard antiplatelet therapy, while the control group (n = 34) received standard therapy alone (acetylsalicylic acid combined with clopidogrel). The treatment duration was 6 months. Pain intensity was assessed using the Visual Analogue Scale, along with the frequency of minor and major lower limb amputations and cases of gastrointestinal bleeding. Results. The addition of cilostazol significantly relieved pain: in 2 months, 84.2 % of patients in the main group experienced pain reduction to ≤ 3 points on the Visual Analogue Scale without the need for additional analgesics, compared to only 11.76 % in the control group (p < 0.001). After 6 months, the proportion of patients who underwent minor amputations was significantly lower in the cilostazol group (7.89 vs. 32.35 %; p = 0.018). The frequency of major amputations did not differ (approximately 5 % in both groups). Cases of gastrointestinal bleeding were rare (5.26 vs. 5.88 %, p > 0.05). No significant adverse effects of cilostazol therapy were identified. Conclusions. In patients with the neuroischemic form of diabetic foot, the addition of cilostazol to standard therapy significantly reduces chronic pain and the need for minor amputations without increasing the risk of gastrointestinal bleeding. Cilostazol can be considered an effective and relatively safe agent in the comprehensive treatment of diabetic foot.

Keywords: diabetic foot syndrome; microcirculation; angioprotector; antiplatelet therapy; diabetes mellitus; neuroischemia; amputation; pain