{ 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

{ {

BackgroundWhy it is important do this review

{ {

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