RT Journal Article
SR Electronic
T1 Successful pharmacologic treatment of lower extremity ulcerations in 5 patients with chronic critical limb ischemia.
JF The Journal of the American Board of Family Practice
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 55
OP 62
VO 15
IS 1
A1 Dean, Steven M
A1 Vaccaro, Patrick S
YR 2002
UL http://www.jabfm.org/content/15/1/55.abstract
AB BACKGROUND Ischemic ulcerations of the distal lower extremities are a manifestation of chronic critical limb ischemia. Without restoration of arterial flow, subsequent gangrene and limb loss can ensue. Unfortunately, revascularization is not always possible.METHODS A literature search of MEDLINE was performed and a case series of 5 patients with lower extremity ischemic ulcerations is described.RESULTS AND CONCLUSION Five patients with severe peripheral artery disease had nonhealing lower extremity ischemic ulcerations. Because 3 patients were not ideal candidates for percutaneous or surgical intervention, and 2 refused invasive therapy, they were treated with cilostazol. Between 7 and 24 weeks after beginning cilostazol therapy, the ulcerations healed in all 5 patients. Three of the patients experienced resolution of concurrent ischemic rest pain. One patient underwent a posttreatment noninvasive arterial study that documented improved large- and small-vessel perfusion. The antiplatelet, antithrombotic, and vasodilatory effects, in addition to possible unrecognized actions of cilostazol, appeared to promote wound healing in this small group of patients with chronic critical limb ischemia. When revascularization is not ideal therapy for ischemic ulcers, a pharmacologic approach with cilostazol might induce healing and obviate limb amputation.