Comparison of sympathectomy and cilostazol treatment results in non-revascularized critical leg ischemia

Year 2021, Volume: 4 Issue: 3, 366 - 371, 21.05.2021

Yıldırım Gültekin Ali Bolat Hüseyin Gemalmaz

https://doi.org/10.32322/jhsm.911909

Abstract

ABSTRACT
Objective: The aim of this retrospective study is to compare the efficacy of sympathectomy and cilostazol therapy in critical limb ischemia that cannot be revascularized.
Material and Method: This study was retrospectively conducted on 30 patients who underwent lumbar sympathectomy (Group 1) and received cilostazol treatment (Group 2) between January 2017 and August 2020. Demographic data, comorbidity, complications, wound healing, walking distance, and pain scale records of the patients were determined by examining the hospital registry system and statistical analysis was performed.
Results: In the study, no significant difference was found between the two groups in terms of walking distance and ischemic pain in the statistical analysis of the data before treatment, at the 3rd, 6th, 12th, and 24th months (p> 0.05). However, a statistically significant difference was found between the pre-treatment data and the data at the 3rd, 6th, 12th, and 24th months in both Group 1 and Group 2 in terms of walking distance and ischemic pain (p˂0.001 ). In the time periods followed in both groups, it was observed that there was an increase in walking distance and a decrease in ischemic pain.
Conclusion: Cilostazol treatment may be preferred as a good alternative treatment method compared to lumbar sympathectomy in critical leg ischemia.
Keywords: Critical leg ischemia; sympathectomy; cilostazol

Keywords

Critical leg ischemia, sympathectomy, cilostazol

References

• Lange S, Diehm C, Darius H, et al. High prevalence of peripheral arterial disease but low antiplatelet treatment rates in elderly primary care patients with diabetes. Diabetes Care 2003; 26: 3357-8.
• Welten GM, Schouten O, Chonchol M, et al. Prognosis of patients with peripheral arterial disease. J Cardiovasc Surg (Torino) 2009; 50: 109-21.
• Meijer WT, Hoes AW, Rutgers D, Bots ML, Hofman A, Grobbee DE. Peripheral arterial disease in the elderly: The Rotterdam Study. Arterioscler Thromb Vasc Biol 1998; 18: 185- 92.
• Tokgözoğlu L, Bariş Kaya E. Atherosclerotic vascular disease and risk factors in Turkey: from past to present. J Atheroscler Thromb 2008; 15: 286-91.
• McDermott MM, Greenland P, Liu K, et al. The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med 2002; 136: 873-83.
• Yao ST, Hobbs JT, Irvine WT. Ankle systolic pressure measurements in arterial disease affecting the lower extremities. Br J Surg 1969; 56: 676-9.
• Gardner AW, Afaq A. Management of lower extremity peripheral arterial disease. J Cardiopulm Rehabil Prev 2008; 28: 349-57.
• Dormandy J, Heeck L, Vig S. The natural history of claudication: risk to life and limb. Semin Vasc Surg 1999; 12: 123-37.
• Akay H, Ersöz A, Yavuzer Ş. Lomber sempatektomi yapılan 322 vakada postoperatif gangren komplikasyonu. Mavi Bülten 1978; 10: 227-38.
• Blumenberg MR, Gelfant M. Sempatectomy for limp salvage Agoal line stand Am J Surg 1979; 138: 241-5.
• .Cross FW. Lumbar sympathectomy. Cardiovasc Surg 1997; 7: 151-4.
• Bozer AY, Günay l. Damar Hastalıkları ve Cerrahisi. 1st ed. Ankara, Hacettepe Üniversitesi Yayınları, 1984.
• Solak H. Göğüs Kalp ve Damar Hastalıkları Cerrahisi. 1st ed. Konya, Atlas Kitabevi, 1992.
• WS Weintraub. The vascular effects of cilostazol. Can J Cardiol 2006; 22: 56-60.
• Crouse III JR, Allan MC, Elam MB. Clinical manifestation of atherosclerotic peripheral arterial disease and the role of cilostazol in treatment of intermittentclaudication. J Clin Pharma col 2002; 42:1291-8.
• Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain. Arthritis Care Res 2011; 63: 240-52
• Bijur PE, Silwer W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 2001; 8: 1153-7.
• Cacione DG, Moreno DH, Nakano LC, Baptista-Silva JC. Surgical sympathectomy for Buerger's disease. JRSM Open 2017; 8: 2054270417717666
• M Pekař, M Mazur, A Pekařová, J Kozák, A Foltys. Lumbar sympathectomy literature review over the past 15 years. Rozhl Chir 2016; 95: 101-6.
• Sen I, Agarwal S, Tharyan P, Forster R. Lumbar sympathectomy versus prostanoids for critical limb ischaemia due to non-reconstructable peripheral arterial disease. Cochrane Database Syst Rev 2018; 4: CD009366.
• SGK. Özür Oranları Cetveli, Resmi Gazete 20.02.2019/30692, https://www.resmigazete.gov.tr/eskiler/2019/02/ 20190220-2.htm
• Berkan Ö, Saba T, Önen A, Uçarı H, Doğan K. Sempatektomi sonuçlarının değerlendirilmesi. Türk Göğüs Kalp Damar Cerrahisi Derg 1999; 7: 263-5.
• Tenna AS, Alex Watson A, Stansby G. Revascularization for critical limb ischemia in diabetes: surgery or angioplasty? Angiology 2014; 65: 272-3
• Lau H, Cheng SW. Buerger’s disease in Hong Kong: a review of 89 cases. Aust N Z J Surg 1997; 67: 264-9.
• Dawson DL, Cutler BS, Meissner MH, Strandness DE Jr. Cilostazol has beneficial effects in treatment of intermittent claudication: Results from a multicenter, randomized, prospective, double-blind trial. Circulation 1998; 98: 678-86.
• Desai K, Han B, Laila Kuziez L, Yan Y, Zayed MA. Literature review and meta-analysis of the efficacy of cilostazol on limb salvage rates after infrainguinal endovascular and open revascularization. Vasc Surg. 2021; 73: 711-21.
• Mya MM, Aronow WS. Increased prevalence of peripheral arterial disease in older men and women with subclinical hypothyroidism. J Gerontol A Biol Sci Med Sci 2003; 58: 68–9.
• Matarazzo A, Rosati Tarulli V, Sassi O, Florio O, Tatafiore M. Possibilities at present for the application of lumbar sympathectomy in occlusive arterial disease of the lower limbs. Minerva Cardioangiol 2002; 50: 363-9.