Lower limb ischemia
Ensure the healthy future
Stop worrying pain in the legs.
“Intermittent claudication” disappears
There is an opportunity to lead a familiar lifestyle.
Autologous Stem Cell Therapy in Critical Limb Ischemia: A Meta-Analysis of Randomized Controlled Trials
Critical limb ischemia (CLI) is the most dangerous stage of peripheral artery disease (PAD) caused by distal tissue hypoxia injury and lack of blood supply, including distal extremity ischemia, ulcers, or gangrene [1, 2]. The prevalence of PAD in the general population is 3% to 10% [3, 4]. The data showed that 11.2% of patients with PAD would deteriorate to CLI each year, and the patient with CLI had the high amputation and mortality rates . Currently, patients in PAD could be treated by percutaneous transluminal angioplasty (PTA) or intravascular thrombolysis [6, 7]; however, 10%–30% of patients with CLI are not candidates for revascularization surgery. Many patients lose the chance of PTA, and the prognosis is poor after surgery, because the patients have peripheral atherosclerosis obliterans, extensive vascular disease, and/or serious damage caused by severe ischemic lesions of limbs [8, 9]. The studies [3, 10] found that vascular remodeling and other means still cannot alleviate the symptoms of ischemia. The amputation rate is 10%–40%, and the mortality rate is up to 20% in patients with CLI within 6 months . The angiogenesis is the optimal treatment for CLI, and autologous stem cell therapy is an emerging alternative treatment [12, 13].
Revascularisation therapy is the current gold standard of care for critical limb ischemia (CLI), although a significant proportion of patients with CLI either are not fit for or do not respond well to this procedure. Recently, novel angiogenic therapies such as the use of autologous cellbased therapy (CBT) have been examined, but the results of individual trials were inconsistent.
Implantation of autologous CBT may be an effective therapeutic strategy for no-option CLI patients. BM-MNC and m-PSBC appear more effective than NCT in improving AR and other limb perfusion parameters. BM-MSC may be beneficial in improving perfusion parameters but not AR, however, this observation needs to be confirmed in a larger population of patients. Generally, treatment using various sources and phenotypes of cell products appeared safe and well tolerated. Large-size RCTs with long follow-up are warranted to determine the superiority and durability of angiogenic potential of a particular CBT and the optimal treatment regimen for CLI.