R. Diaz-Garcia MD, J. Bernardo MD
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{ 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
BackgroundDescription of the Condition
CHRONIC CRITICAL LIMB ISCHEMIA
- due to multiple sites of arterial obstruction
- Manifestations: (>2 weeks)
- ischemic rest pain- Ulceration/gangreneFontaine & Rutherford classification
BackgroundDescription of the Condition
CHRONIC CRITICAL LIMB ISCHEMIA
- Hemodynamic assessment
• ankle systolic pressure of < 50 mm Hg
• toe systolic pressure of 30 mm Hg
• ABI <0.4
Chronic Limb Ischemia
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
BackgroundDescription of the Condition
~500 to 1000 million people suffer per year
- 10% to 40% need to have a limb amputated.
BackgroundDescription of the Condition
• Surgical revascularization • Distal crural or pedal
bypass• Endovascular therapy
• Maximum podiatric wound care• Hyperbaric oxygen• Antibiotics• Vasodilators
Standard Treatment
Treatment Goal
• Increase neovascularization• Improve perfusion index• Decrease rest pain
BackgroundDescription of the Intervention
STEM CELL THERAPY AS A TREATMENT OPTION FOR PATIENTS UNRESPONSIVE TO CURRENT REVASCULARIZATION PROCEDURES
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
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BackgroundWhy it is important do this review
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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
SYSTEMATIC SEARCH2000-2011
PUBMEDMEDLINEYAHOO
6 STUDIES
Key words: Randomized control trialsStem cell therapyCritical limb ischemia
3 STUDIES
Huang et alPerin et al
Prochazka et al
4 STUDIES
INCLUSION /EXCLUSION CRITERIA
STUDY CHARACTERISTICS
STUDY POPULATION
INTERVENTION
OUTCOME
METHODOLOGY
COCHRANECATEGORY
Perin et alMay 2011
CLI patients( n=10)
Autologous BM progenitor cells
ABI at baseline & after 12 weeks
RCT B
Prochazka et alJune 2010
CLI patients(n = 42)
Autologous BMProgenitor cells
ABI at baseline & after 12 weeks
RCT B
Huang et alSept 2005
CLI patients(n=18)
AutologoucPeripheral blood Progenitor cells
ABI at baseline & after 12 weeks
RCT B
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