Successful pharmacologic treatment of lower extremity ulcerations in 5 patients with chronic critical limb ischemia.

Abstract

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.