Long-Term Results of Treatment for Critical Limb Ischemia

Miyahara, Takuya; Suhara, Masamitsu; Nemoto, Yuta; Shirasu, Takuro; Haga, Makoto; Mochizuki, Yasuaki; Matsukura, Mitsuru; Akai, Takafumi; Taniguchi, Rin Ichiro; Nemoto, Masaru; Yamamoto, Satoshi; Nishiyama, Ayako; Hosaka, Akihiro; Hoshina, Katsuyuki; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro; Watanabe, Toshiaki

doi:10.3400/avd.oa.15-00074

Cited by 19 publications

(16 citation statements)

References 16 publications

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“…The AFS rates at 1 and 5 years after the BM-MNC implantation in patients with no-option CLI caused by ASO were 72% and 55%, respectively. 29) So, the limb salvage rate and AFS rate in this study tended to be higher than those in a study by Miyahara et al 4) According to Matoba et al, some param-eters, such as VAS, walking distance, and ulcer diameter, were significantly improved within 6 months after the BM-MNC implantation . 28) The above results showed that the BM-MNC implantation for patients with no-option CLI caused by ASO is an acceptable and feasible therapy.…”

Section: Discussioncontrasting

confidence: 68%

“…Five-year limb salvage rate (83.5% versus 55.8%) and the 5-year amputation-free survival (AFS) rate (57.7% versus 36.0%) were significantly higher in the CLI group subjected to revascularization than in the CLI group without revascularization. 4) However, approximately one-third of patients with CLI cannot undergo surgery for various reasons, including complications (e.g., cardiac/respiratory dysfunction), unfavorable general conditions (e.g., severe dementia, being bedridden, extensive necrosis, or infection), and technical issues (e.g., absence of an artery that can be grafted). 4) Benoit et al showed that the 1-year major AFS rate was 62%-90% and that the 1-year AFS rate was 48%-81% in 2006-2010 for patients with no-option CLI.…”

Section: Discussionmentioning

confidence: 99%

“…4) However, approximately one-third of patients with CLI cannot undergo surgery for various reasons, including complications (e.g., cardiac/respiratory dysfunction), unfavorable general conditions (e.g., severe dementia, being bedridden, extensive necrosis, or infection), and technical issues (e.g., absence of an artery that can be grafted). 4) Benoit et al showed that the 1-year major AFS rate was 62%-90% and that the 1-year AFS rate was 48%-81% in 2006-2010 for patients with no-option CLI. 3) Furthermore, Miyahara et al showed that the 5-year major AFS rate was 55.8%, whereas the 5-year AFS rate was 36.0% in patients with no-option CLI.…”

Section: Discussionmentioning

confidence: 99%

“…3) Furthermore, Miyahara et al showed that the 5-year major AFS rate was 55.8%, whereas the 5-year AFS rate was 36.0% in patients with no-option CLI. 4) Recently, overall survival and major amputation in patients with CLI tend to improve with the development of revascularization and wound care. [32][33][34][35][36] However, approximately 30% of patients with CLI require amputation per year, even after standard revascularization, including EVT or surgical bypass.…”

Section: Discussionmentioning

confidence: 99%

“…3) In patients with TAO or CD, poor long-term patency rate after bypass surgery has been also reported. [4][5][6] In many patients with TAO or CD, bypass surgery is difficult because the peripheral arteries are markedly narrowed. Furthermore, there is no sufficient evidence that shows the benefits of EVT because they often exhibit early recoil or reocclusion owing to vascular properties.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Therapeutic Angiogenesis Using Autologous Bone Marrow-derived Mononuclear Cell Implantation in Patients with No-option Critical Limb Ischemia

Yanishi

Kudoh

Fujioka

et al. 2020

Annals of Vascular Diseases

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Recently, the limb salvage rate of patients with critical limb ischemia (CLI) has been improved due to the development of revascularization and wound care treatment. However, many patients with CLI are refractory to standard treatments, including revascularization such as endovascular treatment or surgical bypass. Establishment of a new cell therapy is required to improve the limb salvage rate and prognosis in patients with CLI. In 1997, endothelial progenitor cells were found to be derived from the bone marrow to circulate as CD34 surface antigen positive cells in peripheral blood and to affect therapeutic angiogenesis in ischemic tissues. Later, therapeutic angiogenesis using autologous bone marrow-derived mononuclear cell (BM-MNC) implantation was performed for patients with no-option CLI in clinical practice. Several reports showed the safety and efficacy of the BM-MNC implantation in patients with CLI caused by arteriosclerosis obliterans, thromboangiitis obliterans (TAO), and collagen diseases. In particular, in patients with CLI caused by TAO, limb salvage rate was significantly improved compared with standard treatments. The BM-MNC implantation may be feasible and safe in patients with no-option CLI. Here, we review the efficacy of BM-MNC implantation in no-option CLI, with a focus on therapeutic angiogenesis.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of Therapeutic Angiogenesis Using Autologous Bone Marrow-derived Mononuclear Cell Implantation in Patients with No-option Critical Limb Ischemia

Yanishi

Kudoh

Fujioka

et al. 2020

Annals of Vascular Diseases

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The efficacy of a multidisciplinary team approach in critical limb ischemia

et al. 2016

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The aim of the present study was to clarify the characteristics of Japanese critical limb ischemia (CLI) patients and analyze the rates of real-world mortality and amputation-free survival (AFS) in all patients with Fontaine stage IV CLI who were treated with/without revascularization therapy by an intra-hospital multidisciplinary care team. All consecutive patients who presented with CLI at Showa University Fujigaoka Hospital between April 2008 and March 2014 were prospectively registered. The intra-hospital committee consisted of cardiologists, plastic surgeons, dermatologists, diabetologists, nephrologists, cardiovascular surgeons, and vascular technologists. The primary endpoint of this study was all-cause mortality and AFS during the follow-up period. The present study included 145 patients with Fontaine stage IV CLI. The mean age was 76.5 ± 10.2 years. The all-cause mortality rate during the follow-up period (15.5 ± 16.1 months) was 21.4 %. The AFS rate during the follow-up period (14.1 ± 16.4 months) was 58.6 %. A multivariate Cox proportional hazards regression analysis found that age >75 years and hemodialysis were significantly associated with all-cause mortality; and that age >75 years, Rutherford 6, and wound infection were significantly associated with AFS. A multidisciplinary approach and comprehensive care may improve the outcomes and optimize the collaborative treatment of CLI patients. However, all-cause mortality remained high in patients with Fontaine stage IV CLI and early referral to a hospital that can provide specialized treatment for CLI, before the occurrence of major tissue loss or infection, is necessary to avoid primary amputation.

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