r. diaz-garcia md, j. bernardo md
DESCRIPTION
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). Background Description of the Condition. CHRONIC CRITICAL LIMB ISCHEMIA - PowerPoint PPT PresentationTRANSCRIPT
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{ R. Diaz-Garcia MD, J. Bernardo MD
Stem Cell Therapy for Patients with Critical Limb Ischemia: A Meta-analysis
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Critical Limb
ischemia (CLI)
the most severe manifestation of peripheral arterial disease (PAD)
BackgroundDescription of the Condition
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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
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BackgroundDescription of the Condition
CHRONIC CRITICAL LIMB ISCHEMIA
- Hemodynamic assessment
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• ankle systolic pressure of < 50 mm Hg
• toe systolic pressure of 30 mm Hg
• ABI <0.4
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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
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BackgroundDescription of the Condition
~500 to 1000 million people suffer per year
- 10% to 40% need to have a limb amputated.
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BackgroundDescription of the Condition
• Surgical revascularization • Distal crural or pedal
bypass• Endovascular therapy
• Maximum podiatric wound care• Hyperbaric oxygen• Antibiotics• Vasodilators
Standard Treatment
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Treatment Goal
• Increase neovascularization• Improve perfusion index• Decrease rest pain
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BackgroundDescription of the Intervention
STEM CELL THERAPY AS A TREATMENT OPTION FOR PATIENTS UNRESPONSIVE TO CURRENT REVASCULARIZATION PROCEDURES
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BackgroundDescription of the Intervention
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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
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Among patients with critical limb ischemia, will
stem cell therapy improve peripheral blood
flow?
Research Question
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To assess the effects of stem cell therapy on critical limb ischemia
Objective
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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
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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
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DiscussionSummary of Main Results
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Stem cell therapy is a promising novel treatment option in CLI patients
ConclusionImplications for Practice
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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
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THANK YOU