Transcript Slide 1

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Stem Cell Therapy for Patients
with Critical Limb Ischemia:
A Meta-analysis
R. Diaz-Garcia MD, J. Bernardo MD
Background
Description of the Condition
Critical Limb
ischemia
(CLI)

the most severe
manifestation of
peripheral arterial
disease (PAD)
Background
Description of the Condition
CHRONIC CRITICAL LIMB
ISCHEMIA
- due to multiple sites of
arterial obstruction
- Manifestations:
(>2 weeks)
- ischemic rest pain
- Ulceration/gangrene
Fontaine & Rutherford
classification
Background
Description 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
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
Background
Description of the Condition
~500 to 1000 million
people suffer per year
- 10% to 40% need to
have a limb
amputated.
Background
Description of the Condition
• Surgical revascularization
• Distal crural or pedal
bypass
• Endovascular therapy
• Maximum podiatric wound
care
• Hyperbaric oxygen
• Antibiotics
• Vasodilators
Treatment Goal
• Increase neovascularization
• Improve perfusion index
• Decrease rest pain
Background
Description of the Intervention
Background
Description of the Intervention
Background
Description of the Intervention

direct incorporation and
proliferation into the endothelial
layer of existing blood vessels

by paracrine effects on mature
endothelial cells.
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Background
Why it is important do this review
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Background
Why it is important do this review
Research Question
Among patients with critical
limb ischemia, will stem cell
therapy improve peripheral
blood flow?
Objective

To assess the effects
of stem cell therapy
on critical limb
ischemia
PUBMED
MEDLINE
YAHOO
Key words:
Randomized
control trials
Stem cell therapy
Critical limb
ischemia
SYSTEMATIC
SEARCH
2000-2011
6 STUDIES
INCLUSION /EXCLUSION
CRITERIA
Huang et al
Perin et al
Prochazka et al
4 STUDIES
3 STUDIES
STUDY
POPULATI
ON
INTERVEN
TION
OUTCOME METHO
COCHRANE
DOLOGY CATEGORY
Perin et al
May 2011
CLI patients Autologous
( n=10)
BM
progenitor
cells
ABI at
baseline &
after 12
weeks
RCT
B
Prochazka
et al
June 2010
CLI patients Autologous
(n = 42)
BM
Progenitor
cells
ABI at
baseline &
after 12
weeks
RCT
B
Huang et al
Sept 2005
CLI patients Autologouc
(n=18)
Peripheral
blood
Progenitor
cells
ABI at
baseline &
after 12
weeks
RCT
B
STUDY CHARACTERISTICS
Discussion
Summary of Main Results
Conclusion
Implications for Practice
Stem cell therapy is a promising
novel treatment option in CLI
patients

Conclusion
Implications for Research

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