Successful Pharmacologic Treatment of Lower Extremity Ulcerations in 5 Patients With Chronic Critical Limb Ischemia

Steven M. Dean, DO, Patrick S. Vaccaro, MD

Disclosures

J Am Board Fam Med. 2002;15(1) 

In This Article

Abstract and Introduction

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, anti-thrombotic, 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.

Peripheral artery disease is a disorder typically caused by atherosclerosis that limits blood flow to the limbs. Most patients with peripheral artery disease are either asymptomatic or complain of intermittent claudication (exertional leg pain that is promptly relieved with rest). A minority, however, develop chronic critical limb ischemia whereby the integrity of the limb is jeopardized. In this scenario, peripheral artery disease is complicated by ischemic rest pain, nonhealing ulcerations, or gangrene. Without restoration of limb perfusion, the patient who has peripheral artery disease and chronic critical limb ischemia is at high risk for limb loss. Yet revascularization might not be technically possible. As a result, pharmacotherapy is sometimes used as a last resort for improving the manifestations of chronic critical limb ischemia. Unfortunately, limb salvage is rarely achieved with a pharmaceutic approach. In this article, we describe ischemic ulcerations in 5 patients that were successfully treated with cilostazol.

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