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Abstract
Conventionally, revascularization by either interventional recanalization or bypass surgery is considered the therapy of choice in patients with critical limb ischaemia. However, in the presence of long-distance vascular occlusions with peripheral vessels too small to provide sufficient run-off for successful revascularization strategies, only conservative options are left. In these patients, various pharmacological interventions have been tried in the past with little long-lasting effects.
This study showed that arterial reconstruction or prevention of arterial obstruction using stem cells controls the rest pain and shortens the healing process of ischemic ulcers. The specific mechanism and the reason for the rapid improvement in the patient still remain to be fully explained. The possible explanations for these dramatic effects are as follows: 1) stem cells are able to produce a large amount of cytokines and growth factors; 2) stem cells can directly reconstitute arterioles.
Stem cells can be directed in combination with other technologies, such as tissue engineering for the growth of highly organized tissues in the laboratory as blood vessels for example to be implanted in patients.
Despite considerable advances in the therapy of patients with peripheral arterial occlusive disease and critical limb ischaemia, a substantial number remain, in whom amputation has to be considered the only and final option. These are the patients that most benefit from stem cell therapy as the final and only hope of limb salvage.