R. Diaz-Garcia MD, J. Bernardo MD

R. Diaz-Garcia MD, J. Bernardo MD Stem Cell Therapy for Patients with Critical Limb Ischemia: A Meta-analysis

Critical Limb ischemia (CLI) • the most severe manifestation of peripheral arterial disease (PAD) BackgroundDescription of the Condition

CHRONIC CRITICAL LIMB ISCHEMIA • due to multiple sites of arterial obstruction • Manifestations: • (>2 weeks) • ischemic rest pain • Ulceration/gangrene • Fontaine & Rutherford classification BackgroundDescription of the Condition

CHRONIC CRITICAL LIMB ISCHEMIA • Hemodynamic assessment BackgroundDescription of the Condition

ankle systolic pressure of < 50 mm Hg • toe systolic pressure of 30 mm Hg • ABI <0.4

RISK FACTORS THAT REDUCE BLOOD FLOW • Diabetes Mellitus • Renal Failure • Severely decreased Cardiac Output • Smoking • Vasospastic disease • RISK FACTORS THAT INCREASE BLOOD FLOW • Infection • Skin Breakdown • Trauamatic Injury Chronic Limb Ischemia

~500 to 1000 million people suffer per year • 10% to 40% need to have alimb amputated. BackgroundDescription of the Condition

Standard Treatment • Surgical revascularization • Distal crural or pedal bypass • Endovascular therapy • Maximum podiatric wound care • Hyperbaric oxygen • Antibiotics • Vasodilators BackgroundDescription of the Condition

Treatment Goal • Increase neovascularization • Improve perfusion index • Decrease rest pain

STEM CELL THERAPY AS A TREATMENT OPTION FOR PATIENTS UNRESPONSIVE TO CURRENT REVASCULARIZATION PROCEDURES BackgroundDescription of the Intervention

BackgroundDescription of the Intervention

direct incorporation and proliferation into the endothelial layer of existing blood vessels • by paracrine effects on mature endothelial cells. BackgroundDescription of the Intervention

BackgroundWhy it is important do this review

Among patients with critical limb ischemia, will stem cell therapy improve peripheral blood flow? Research Question

To assess the effects of stem cell therapy on critical limb ischemia Objective

PUBMED MEDLINE YAHOO Key words: Randomized control trials Stem cell therapy Critical limb ischemia INCLUSION /EXCLUSION CRITERIA Huang et al Perin et al Prochazka et al 6 STUDIES SYSTEMATIC SEARCH 2000-2011 4 STUDIES 3 STUDIES

STUDY CHARACTERISTICS

DiscussionSummary of Main Results

Stem cell therapy is a promising novel treatment option in CLI patients ConclusionImplications for Practice

The use of stem cell therapy on a larger population • Future studies on adverse side effects, quality of life and cost effectiveness of treatment • The long term effects of the use of stem cell therapy ConclusionImplications for Research

THANK YOU

R. Diaz-Garcia MD, J. Bernardo MD

R. Diaz-Garcia MD, J. Bernardo MD

Presentation Transcript

Greggory R. DeVore MD

J. Varon, MD, FCCP , W.F. Peacock, MD, N. Garrison, MD, R. Ebrahimi, MD, L. Dunbar, MD, P. Acosta, MD, and C. Pollack, M

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A Kheirkhah MD, A Izadi MD, R Nazari MD H Hashemi MD, M Jabbarvand MD, H Hashemian MD

Glenn R. Buttermann, MD

R. Cionni, MD

J. Stephen Huff, MD

Peter Pronovost, MD John R. Combes, MD

Lester J Peters MD

R Rodríguez-Roisin, MD

Robert R. Althoff, MD, PhD; James J. Hudziak, MD; Frank C. Verhulst, MD, PhD;

Robert J. Master, MD

Bokkwan Jun MD, John P Berdahl MD, Anthony N Kuo MD, Thomas J Cummings MD, Terry Kim MD

J. Stephen Huff, MD

KIR POLYMORPHISM Christian Garcia, MD

James J. Ferguson, MD

Paul J. Davis, MD

Stuart J. Farber, MD

Barry J Klyde MD