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The Cochrane Database of Systematic... Dec 2011Peripheral arterial disease (PAD) is a major health problem and in about 1% to 2% of patients the disease progresses to critical limb ischaemia (CLI). In a substantial... (Review)
Review
BACKGROUND
Peripheral arterial disease (PAD) is a major health problem and in about 1% to 2% of patients the disease progresses to critical limb ischaemia (CLI). In a substantial number of patients with CLI, no effective treatment option other than amputation is available and around a quarter of these patients will require a major amputation during the following year.
OBJECTIVES
To determine the effectiveness and safety of autologous adult bone marrow derived mononuclear cells (BMMNCs) as a treatment for CLI.
SEARCH METHODS
The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched November 2010) and CENTRAL (2010, Issue 4). We searched the reference lists of identified articles.
SELECTION CRITERIA
All randomised controlled trials of CLI in which participants were randomly allocated to intramuscular administration of autologous adult BMMNCs or control (either no intervention or conventional conservative therapy) were included. Studies on patients with intermittent claudication were not included.
DATA COLLECTION AND ANALYSIS
Two authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data. Disagreements were resolved by consensus or by the third author.
MAIN RESULTS
Thirty-seven potential studies were identified after initial screening of titles and abstracts. Only two small studies, with a combined total of 57 patients, met our inclusion criteria and were finally included. In one study the effects of intramuscular injections of BMMNCs in the ischaemic lower limbs of patients with CLI were compared with control (standard conservative treatment). No deaths were reported and no significant difference was observed between the two groups for either pain (P = 0.37) or the ankle brachial pressure index (ABI) parameter. However, the treatment group showed a significantly smaller proportion of participants undergoing amputation compared with the control group (P = 0.026).In the other study, following subcutaneous injections of granulocyte colony-stimulating factor (G-CSF) for five days peripheral blood derived mononuclear cells were collected and then transplanted by intramuscular injections into ischaemic lower limbs. The effects were compared with daily intravenous prostaglandin E1 injections (control group). No deaths were reported. Pain reduction was greater in the treatment group than in the control group (P < 0.001) as was increase in ABI (mean increase 0.13 versus 0.02, P < 0.01). The treatment group experienced a statistically significant increase in pain-free walking distance compared with the control group (mean increase 306.4 m versus 78.6 m, P = 0.007). A smaller proportion of participants underwent amputation in the treatment group compared with the control group (0% versus 36%, P = 0.007).
AUTHORS' CONCLUSIONS
The data from the published trials suggest that there is insufficient evidence to support this treatment. These results were based on only two trials which had a very small number of participants. Therefore evidence from larger randomised controlled trials is needed in order to provide adequate statistical power to assess the role of intramuscular mononuclear cell implantation in patients with CLI.
Topics: Adult; Amputation, Surgical; Bone Marrow Transplantation; Humans; Injections, Intramuscular; Ischemia; Leg; Leukocytes, Mononuclear; Pain Measurement; Peripheral Vascular Diseases; Randomized Controlled Trials as Topic; Transplantation, Autologous
PubMed: 22161427
DOI: 10.1002/14651858.CD008347.pub2 -
Diabetic Medicine : a Journal of the... Mar 2005To explore mechanisms by which temperature could influence the pathogenesis and symptoms of diabetic polyneuropathy. (Review)
Review
AIM
To explore mechanisms by which temperature could influence the pathogenesis and symptoms of diabetic polyneuropathy.
METHODS
We conducted a literature review attempting to identify mechanisms by which diabetic polyneuropathy could be affected by temperature.
RESULTS
Cooling can theoretically hasten the progression of diabetic polyneuropathy through several different mechanisms. Specifically, cooling can enhance neuronal ischaemia, increase formation of reactive oxygen species, slow axonal transport, increase protein kinase C activity, and interfere with immune function. Short-term temperature fluctuations (both warming and cooling) can initiate and exacerbate neuropathic pain by causing neuronal hyperexcitability and functional deafferentation. Although normal fluctuations of distal extremity temperature may be sufficient for these effects, impaired thermoregulation may make the distal extremities more susceptible to temperature extremes. Eventually, a 'vicious cycle' may ensue, resulting in neuronal deterioration with further disruption of temperature regulation. Limited epidemiological data suggest a higher prevalence of diabetic polyneuropathy in populations living in colder locations, supporting our hypothesis.
CONCLUSIONS
Variations in foot temperature may play an important but as yet unrecognized role in the development and symptoms of diabetic polyneuropathy. Further basic and clinical research exploring this concept could help elucidate the natural history of diabetic polyneuropathy and lead to novel therapeutic strategies.
Topics: Body Temperature; Body Temperature Regulation; Cold Temperature; Diabetic Neuropathies; Disease Progression; Foot; Humans; Ischemia; Pain; Peripheral Nervous System
PubMed: 15717867
DOI: 10.1111/j.1464-5491.2005.01486.x -
Heart (British Cardiac Society) Jan 2016Stem cell (SC) administration is a potential therapeutic strategy to improve blood supply in patients with peripheral artery disease (PAD). The aim of this systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Stem cell (SC) administration is a potential therapeutic strategy to improve blood supply in patients with peripheral artery disease (PAD). The aim of this systematic review and meta-analysis was to investigate the efficacy of extraembryonic tissue-derived SC (ETSC) in improving blood flow within animal models of hindlimb ischaemia (HLI).
METHODS
PubMed, ScienceDirect and Web of Science were searched to identify studies which investigated ETSCs within animal HLI models. A meta-analysis was performed focusing on the effect of ETSCs on limb blood flow assessed by laser Doppler imaging using a random effects model. Methodological quality was assessed using a newly devised quality assessment tool.
RESULTS
Five studies investigating umbilical cord-derived SCs (three studies), placental SCs (one study), amnion and chorionic SCs (one study) were included. A meta-analysis suggested that administration of ETSCs improved the restoration of blood flow within the HLI models used. The methodological quality of the included studies was assessed as poor. Problems identified included lack of randomised design and blinding of outcome assessors; that the animal models did not incorporate recognised risk factors for human PAD or atherosclerosis; the models used did not have established chronic ischaemia as is the cases in most patients presenting with PAD; and the studies lacked a clear rationale for the dosage and frequency of SCs administered.
CONCLUSIONS
The identified studies suggest that ETSCs improve recovery of limb blood supply within current animal HLI models. Improved study quality is, however, needed to provide support for the likelihood of translating these findings to patients with PAD.
Topics: Animals; Blood Flow Velocity; Disease Models, Animal; Embryonic Stem Cells; Hindlimb; Humans; Ischemia; Muscle, Skeletal; Peripheral Arterial Disease; Phenotype; Recovery of Function; Regional Blood Flow; Stem Cell Transplantation
PubMed: 26573094
DOI: 10.1136/heartjnl-2015-308322 -
The British Journal of Ophthalmology May 2012To determine the relationship between retinal ischaemia and the presence of macular oedema (DMO) in patients with diabetic retinopathy (DR) using ultra-widefield...
PURPOSE
To determine the relationship between retinal ischaemia and the presence of macular oedema (DMO) in patients with diabetic retinopathy (DR) using ultra-widefield fluorescein angiography (UWFA) imaging.
METHODS
A retrospective review of 122 eyes of 70 treatment-naïve diabetic patients who underwent diagnostic UWFA using the Optos 200Tx imaging system. Two independent, masked graders quantified the area of retinal ischaemia. Based on clinical examination and optical coherence tomography (OCT), each patient was given a binary classification as either having DMO or no DMO. McNemar's test (with Yates' correction as indicated) and a two-sample test of proportions were used to determine the relationship between DMO and ischaemia for binary and proportional data, respectively. Linear and logistic models were constructed using generalised estimating equations to test relationships between independent variables, covariates and outcomes while controlling for inter-eye correlation, age, gender, haemoglobin A1c, mean arterial pressure and dependence on insulin.
RESULTS
Seventy-six eyes (62%) exhibited areas of retinal ischaemia. There was a significant direct correlation between DMO and peripheral retinal ischaemia as seen on UWFA (p<0.001). In addition, patients with retinal ischaemia had 3.75 times increased odds of having DMO compared with those without retinal ischaemia (CI 1.26 to 11.13, p<0.02).
CONCLUSION
Retinal ischaemia is significantly correlated with DMO in treatment-naïve patients with DR. UWFA is a useful tool for detecting peripheral retinal ischaemia, which may have direct implications in the diagnosis, follow-up and treatment such as targeted peripheral photocoagulation.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Diabetic Retinopathy; Female; Fluorescein Angiography; Humans; Ischemia; Macular Edema; Male; Middle Aged; Retinal Vessels; Retrospective Studies; Tomography, Optical Coherence; Young Adult
PubMed: 22423055
DOI: 10.1136/bjophthalmol-2011-300774 -
EuroIntervention : Journal of EuroPCR... Feb 2020
Topics: Heart; Heart-Assist Devices; Humans; Ischemia; Shock, Cardiogenic
PubMed: 30295295
DOI: 10.4244/EIJ-D-18-00797 -
European Journal of Vascular and... Jan 2022To perform a scoping review of how patients with COVID-19 are affected by acute limb ischaemia (ALI) and evaluate the recommendations of the 2020 ESVS ALI Guidelines for... (Review)
Review
Editor's Choice - Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature.
OBJECTIVE
To perform a scoping review of how patients with COVID-19 are affected by acute limb ischaemia (ALI) and evaluate the recommendations of the 2020 ESVS ALI Guidelines for these patients.
METHODS
Research questions were defined, and a systematic literature search was performed following the PRISMA guidelines. Abstracts and unpublished literature were not included. The definition of ALI in this review is in accordance with the ESVS guidelines.
RESULTS
Most identified papers were case reports or case series, although population based data and data from randomised controlled trials were also identified. In total, 114 unique and relevant papers were retrieved. Data were conflicting concerning whether the incidence of ALI increased, or remained unchanged, during the pandemic. Case reports and series reported ALI in patients who were younger and healthier than usual, with a greater proportion affecting the upper limb. Whether or not this is coincidental remains uncertain. The proportion of men/women affected seems unchanged. Most reported cases were in hospitalised patients with severe COVID-19. Patients with ALI as their first manifestation of COVID-19 were reported. Patients with ALI have a worse outcome if they have a simultaneous COVID-19 infection. High levels of D-dimer may predict the occurrence of arterial thromboembolic events in patients with COVID-19. Heparin resistance was observed. Anticoagulation should be given to hospitalised COVID-19 patients in prophylactic dosage. Most of the treatment recommendations from the ESVS Guidelines remained relevant, but the following were modified regarding patients with COVID-19 and ALI: 1) CTA imaging before revascularisation should include the entire aorta and iliac arteries; 2) there should be a high index of suspicion, early testing for COVID-19 infection and protective measures are advised; and 3) there should be preferential use of local or locoregional anaesthesia during revascularisation.
CONCLUSION
Although the epidemiology of ALI has changed during the pandemic, the recommendations of the ESVS ALI Guidelines remain valid. The above mentioned minor modifications should be considered in patients with COVID-19 and ALI.
Topics: COVID-19; COVID-19 Testing; Humans; Ischemia; Peripheral Arterial Disease; SARS-CoV-2; Vascular Surgical Procedures
PubMed: 34686452
DOI: 10.1016/j.ejvs.2021.08.028 -
Trends in Neurosciences Nov 2000The strange and unpleasant sensations (paraesthesiae) or asynchronous motor-unit activation (fasciculation) that result from a period of limb ischaemia are examples of... (Review)
Review
The strange and unpleasant sensations (paraesthesiae) or asynchronous motor-unit activation (fasciculation) that result from a period of limb ischaemia are examples of ectopic discharge in peripheral nerves. Ectopic activity also results from demyelination and is associated with serious neurological conditions, such as multiple sclerosis. A build-up of extracellular K(+) in the internode and persistent Na(+) currents are now implicated in generating the different forms of activity arising in normal and demyelinated axons.
Topics: Animals; Axons; Electrophysiology; Extremities; Humans; Ischemia; Models, Neurological; Oscillometry; Paresthesia
PubMed: 11074260
DOI: 10.1016/s0166-2236(00)01645-3 -
Angiologiia I Sosudistaia Khirurgiia =... 2020Cell therapy was proposed as a procedure of indirect revascularization for patients with critical ischaemia of lower extremities for whom endovascular and surgical... (Review)
Review
BACKGROUND
Cell therapy was proposed as a procedure of indirect revascularization for patients with critical ischaemia of lower extremities for whom endovascular and surgical revascularization is impossible. We present herein a review of the state of the art of studies in the field of cell therapy of this cohort of patients.
BASIC PROVISIONS
Cell therapy has proved safe, however, the results of studies of efficacy are relatively ambiguous and unconvincing. The number of patients in separately taken clinical trials is minimal. The reviewed studies differed not only by heterogeneity of the cell types used but by the routes of administration of cells (cells were delivered either intramuscularly (predominantly) or intraarterially) and the duration of follow up (time of assessment and duration of follow up varied from 1 month to 2 years). One of the problems became the lack of the routine study of the angiogenic potential of stem cells prior to their clinical application. It is known that the angiogenic activity of multipotent cells of apparently healthy patients may differ from that of patients suffering from atherosclerosis, chronic renal failure, diabetes.
CONCLUSIONS
It is supposed that treatment with stem cells or precursor cells is more efficient as compared to protein or gene therapy not only owing to direct vasculogenic properties but a paracrine action through excretion of proangiogenic biologically active substances. More studies with larger cohorts are necessary to provide stronger safety and efficacy data on cell therapy. Besides, a promising trend in the field of cellular approaches is modulation of regenerative capability of stem cells, which may help overcome difficulties in understanding the place of cell therapy in therapeutic angiogenesis.
Topics: Cell- and Tissue-Based Therapy; Genetic Therapy; Humans; Ischemia; Lower Extremity; Stem Cells
PubMed: 32597882
DOI: 10.33529/ANGIO2020220 -
BMJ Case Reports Aug 2017
Topics: Arm; Arteriovenous Shunt, Surgical; Constriction, Pathologic; Diagnosis, Differential; Humans; Ischemia; Male; Middle Aged; Peripheral Vascular Diseases; Renal Dialysis; Syndrome; Ultrasonography
PubMed: 28775113
DOI: 10.1136/bcr-2017-221436 -
Rozhledy V Chirurgii : Mesicnik... 2023This case report describes surgical treatment of chronic mesenteric ischemia in a polymorbid patient with the history of an aorto-bifemoral bypass implant.
INTRODUCTION
This case report describes surgical treatment of chronic mesenteric ischemia in a polymorbid patient with the history of an aorto-bifemoral bypass implant.
CASE REPORT
The patient suffered from chronic occlusions of the mesenteric arteries. He experienced postprandial pain and significant weight loss. Endovascular repair of the occlusions failed. Open single retrograde bypass from the left branch of the aorto-bifemoral graft to the superior mesenteric artery was implanted successfully.
CONCLUSION
The discussion briefly mentions current trends in the treatment of chronic mesenteric ischemia. Despite the development of interventional radiology, surgical treatment remains a relevant alternative for the management of chronic mesenteric ischemia.
Topics: Male; Humans; Mesenteric Ischemia; Treatment Outcome; Mesenteric Vascular Occlusion; Vascular Surgical Procedures; Intestines; Ischemia; Chronic Disease
PubMed: 37527947
DOI: 10.33699/PIS.2023.102.5.204-207