Lower extremity critical limb ischemia: A review of clinical features and management

Levin, Scott R.; Arinze, Nkiruka; Siracuse, Jeffrey J.

doi:10.1016/j.tcm.2019.04.002

Cited by 59 publications

(48 citation statements)

References 32 publications

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“…As the end stage of peripheral artery disease, critical limb ischemia (CLI) is characterized by rest pain and tissue loss with a 6‐month mortality rate of approximately 20% 1,2 . Owing to a high postoperative reocclusion rate and poor anatomical conditions, 20%‐50% of patients with CLI are not suitable for either surgical or endovascular treatment and are also called no‐option CLI (NO‐CLI) patients 3 .…”

Section: Introductionmentioning

confidence: 99%

Three-year outcomes of peripheral blood mononuclear cells vs purified CD34+ cells in the treatment of angiitis-induced no-option critical limb ischemia and a cost-effectiveness assessment: A randomized single-blinded noninferiority trial

Líu

Pan

Fang

et al. 2021

Stem Cells Translational Medicine

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For patients with angiitis‐induced critical limb ischemia (AICLI), cell transplantation, such as purified CD34+ cells (PCCs) and peripheral blood mononuclear cells (PBMNCs), is gradually being used as a promising treatment. This was the first randomized single‐blinded noninferiority trial (number: NCT 02089828) specifically designed to evaluate the therapeutic efficacies of the transplantation of PCCs vs those of PBMNCs for the treatment of AICLI. We aimed to compare the mid‐term safety and efficacy between the two groups and determine their respective advantages. From April 2014 to September 2019, 50 patients with AICLI were equally allocated to the two groups, except for 1 lost patient, 1 amputee, and 1 patient who died of heart disease. The other 47 patients completed the 36‐month follow‐up. The endpoints were as follows: major amputation‐free survival and total amputation‐free survival at 6 months, which were 96.0% and 84.0% in the PBMNCs group and 96.0% and 72.0% in the PCCs group, respectively. These rates remained stable at 12, 24, and 36 months. The PCCs group had a significant higher probability of rest pain relief than the PBMNCs group, whereas earlier significant improvements in the Rutherford classification were observed in the PBMNCs group. Accordingly, PCCs would be preferred for patients with significant pain, whereas PBMNCs may be a good option for patients with two or more critically ischemic limbs. Concerning cost‐effectiveness, PCCs are not more cost‐effective than PBMNCs. These outcomes require verification from long‐term trials involving larger numbers of patients.

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Section: Introductionmentioning

confidence: 99%

Three-year outcomes of peripheral blood mononuclear cells vs purified CD34+ cells in the treatment of angiitis-induced no-option critical limb ischemia and a cost-effectiveness assessment: A randomized single-blinded noninferiority trial

Líu

Pan

Fang

et al. 2021

Stem Cells Translational Medicine

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“…About 10% of patients with PAD have CLI, a serious complication defined by tissue damage and/or ischemic pain at rest. Risk factors such as smoking and diabetes increase the likelihood of progression to CLI by three- and four-fold, respectively [ 9 ]. Treatment requires interdisciplinary care in order to control symptoms, manage wounds, and revascularize.…”

Section: Discussionmentioning

confidence: 99%

Improving Symptoms of Peripheral Artery Disease With Hirudotherapy

Afify¹,

Alkhouri²,

Lauder³

2021

Cureus

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Peripheral artery disease (PAD) is a significant cause of morbidity and mortality in the world. Critical limb ischemia is a complication of PAD that leads to severe pain at rest, numbness, and absent or diminished pulses in the legs or feet. Revascularization with surgery or endovascular intervention is required to reestablish blood flow to the affected areas. Failure to respond to medical and/or surgical treatment can lead to amputations. The decision to amputate one's limb can be very challenging. Here, we report a patient with critical limb ischemia who refused a below-the-knee amputation and self-treated with medicinal leech therapy, or hirudotherapy. His symptoms including his pain, burning, and numbness improved significantly following six months of therapy.

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“…Functional limb recovery and survival rate improvement, as well as patient quality of life, are the critical goals of CLTI clinical management. [ 4 ] Revascularization strategies, currently in use, involve surgical intervention through endovascular techniques or bypass that aim at removing or bypassing the occlusion. [ 3 ]…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Biomaterial Approaches to Alleviate Chronic Limb Threatening Ischemia

2021

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Chronic limb threatening ischemia (CLTI) is a severe condition defined by the blockage of arteries in the lower extremities that leads to the degeneration of blood vessels and is characterized by the formation of non‐healing ulcers and necrosis. The gold standard therapies such as bypass and endovascular surgery aim at the removal of the blockage. These therapies are not suitable for the so‐called “no option patients” which present multiple artery occlusions with a likelihood of significant limb amputation. Therefore, CLTI represents a significant clinical challenge, and the efforts of developing new treatments have been focused on stimulating angiogenesis in the ischemic muscle. The delivery of pro‐angiogenic nucleic acid, protein, and stem cell‐based interventions have limited efficacy due to their short survival. Engineered biomaterials have emerged as a promising method to improve the effectiveness of these latter strategies. Several synthetic and natural biomaterials are tested in different formulations aiming to incorporate nucleic acid, proteins, stem cells, macrophages, or endothelial cells in supportive matrices. In this review, an overview of the biomaterials used alone and in combination with growth factors, nucleic acid, and cells in preclinical models is provided and their potential to induce revascularization and regeneration for CLTI applications is discussed.

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Lower extremity critical limb ischemia: A review of clinical features and management

Cited by 59 publications

References 32 publications

Three-year outcomes of peripheral blood mononuclear cells vs purified CD34+ cells in the treatment of angiitis-induced no-option critical limb ischemia and a cost-effectiveness assessment: A randomized single-blinded noninferiority trial

Three-year outcomes of peripheral blood mononuclear cells vs purified CD34+ cells in the treatment of angiitis-induced no-option critical limb ischemia and a cost-effectiveness assessment: A randomized single-blinded noninferiority trial

Improving Symptoms of Peripheral Artery Disease With Hirudotherapy

Therapeutic Biomaterial Approaches to Alleviate Chronic Limb Threatening Ischemia

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