There have been great progresses in our knowledge of patho-physiology on various cardiovascular diseases, which enabled us to develop the field of regenerative medicine for previously untreatable patients. Among several strategies in cardiovascular regenerative medicine, cell transplantation is one of the best studied and the best clinically practiced. In this review we will first summarize the mechanisms of cell therapy, and then go through lists of cells and diseases that can be applied. Later we will introduce some of the clinical experiences published so far, with some discussion regarding the problems and perspectives of this novel therapeutics.
Weak oral bacteria such as periodontal bacteria or Chlamydia pneumoniae have been observed in various arterial and venous lesions with epidemiological data reported prior to the discovery of bacterial invasion into vessels. Rich lymph vessels easily bring the bacteria from the mouth to the neck and the venous angle, which is directly open to the blood vessels. Periodontal bacteria travel within platelets and Chlamydia pneumoniae can be carried by monocytes. The transportation system of other weak oral bacteria have not been determined. Periodontal bacteria, especially P. gingivalis aggregate platelets and form thrombi. At the same time, secretions such as serotonin, various cytokines, and adhesion factors also appear in the blood. The characteristics of arterial lesions are dependent on the age of the patient and the condition of the endothelial cells. In young patients, infectious incidents occur due to embolic mechanisms in Buerger disease or adhesion to the superficial veins valves in varicose veins. In older patients, incidents result in adhesion in the proximal aorta, coronary arteries, or large arteries. The hypothesis here unifies the evidence on vessel lesion development and explains the possible discrepancy between vascular diseases.
The clinical and social characteristics of 118 patients with Buerger’s disease (thromboangiitis obliterans: TAO) were surveyed. The prognosis for many patients is relatively favorable. Arterial reconstruction plays a role in shortening the healing times of ischemic ulcers despite its poor long-term results. Of 118 patients, 13 underwent major lower limb amputation (11%), 33 underwent foot or toe amputation (28%), one underwent hand amputation (1%), and 12 underwent finger amputations (10%) after the onset of the disease. The progression of symptoms was surely influenced by smoking, but this was not the only deleterious factor as there were patients with stable TAO which was unaffected by their continued smoking. In 66 patients, the new occurrence of ulceration and gangrene was not observed over the age of 60. Ten of 13 patients (77%) who underwent major lower limb amputation lost their jobs, but only 7 of 105 patients without major amputation lost their jobs (7%). In all patients, the progression of symptoms was self-limited and recurrent ulcers occurred less frequently with ageing. To avoid factors that markedly influence the quality of life, early treatment and strict instructions prohibiting smoking should be conducted.
Endovascular treatment of acute and chronic iliac vein occlusions has proven to be safe and effective. Recanalization of chronic occlusions with balloon angioplasty and stenting can re-establish normal venous flow in the iliac veins and the IVC and relieve symptoms in the majority of treated patients. CDT with recanalization and stenting of underlying chronically obstructed iliofemoral segments is becoming the treatment of choice for patients with acute iliofemoral thrombosis, as anticoagulation and compression therapy alone are not satisfactory in preventing PTS. The new treatment modalities offer stimulating options for a patient group that is not adequately treated, neither by medical nor open surgical therapy. The substantial effort and additional costs of endovascular treatment appear to be justified by the encouraging mid-term results both for patients with acute and chronic occlusive iliofemoral disease. However, multi-center randomized prospective studies are required to further validate the role of these techniques.
Background: The Walking Impairment Questionnaire (WIQ) measures walking ability in daily life in patients with peripheral arterial disease causing intermittent claudication. We investigated the efficacy of sarpogrelate, a 5-HT2A receptor antagonist, in improving walking ability, as measured using new Japanese version of the WIQ. Patients and Methods: A nationwide multicenter study was conducted at 80 institutions in Japan involving 586 patients with stable symptoms of intermittent claudication. Patients received open-label sarpogrelate 300 mg/day. A total of 419 patients were evaluated in the full analysis set (FAS) following the intention to treat principle, and 354 patients were evaluated in the per-protocol set (PPS). The FAS data are emphasized here. Results: The mean follow-up was 27.7 ± 10.1 weeks. Each subscale of the WIQ score showed improvement after sarpogrelate treatment (p < 0.0001), and the resting ankle-brachial index increased significantly (p < 0.0001). The incidence of adverse reactions of the entire series of 559 patients was 4.83% (27 patients), but there were no clinically significant safety concerns. Conclusions: We have for the first time demonstrated that sarpogrelate may improve walking ability in daily life in Japanese patients with intermittent claudication. The drug had a good safety profile.
Objective: We investigated the effect of immersion of feet in CO2 -enriched water for preventing expansion and formation of ischemic ulcer in critical limb ischemia of diabetic patients after surgical revascularization. Materials and methods: Eligible patients were allocated CO2 group (CO2 immersion plus standard care) or control group (standard care alone) and were followed up for 3 months after surgical revascularization. The end point is defined as an expansion of a target ulcer (more than 101% of original size) or the formation of new ulcers during the follow-up period. Results: Fifty-nine patients out of originally enrolled 66 patients with type II diabetes were included in intention-to-treat population. The cumulative prevention rate for ischemic ulcer after 3 months was 97.1% in the CO2 group, while, in the control group, it was 77.8%, i.e., significantly lower than the CO2 group (P = 0.012, log-rank test). The transcutaneous oxygen pressure increased significantly only in the CO2 group, from 56 ± 14 to 63 ± 15 mmHg (P < 0.01, Wilcoxon signed rank test), in 3 months. Conclusion: These results suggest that addition of CO2 immersion to standard care of critical limb ischemia in diabetic patients improves early postoperative outcome after vascular surgery.
Only a few cases of endoleak following conventional abdominal aortic aneurysm repair have been reported. We treated a patient with a type I endoleak-like phenomenon occuring 12 years after conventional abdominal aortic aneurysm repair. Computed tomography demonstrated dilation of the surgically replaced, once-shrunken aneurysm sac to a diameter of 3.5 cm. Thrombus was identified between the graft and the sac. Four months later the sac ruptured, and emergency repair was performed. Dehiscence of the proximal anastomosis causing dilation and tearing of the sac was found. Dilation of a surgically replaced aneurysm sac after initial shrinkage may suggest an endoleak-like phenomenon requiring second repair.