Epidemiological studies in Western countries indicate that up to 5% of men and 2.5% of women 60 years of age or older have symptoms of intermittent claudication. The symptoms of chronic arterial insufficiency of the lower extremities progress rather slowly over time. Thus, after 5 to 10 years, more than 70% of patients report either no change or improvement in their symptoms, while 20% to 30% have progressive symptoms and require intervention, and less than 10% need amputation.
With respect to affected limbs, the goal is to eliminate ischemic symptoms and prevent progression to vascular occlusion. Accepted treatments include nonsurgical measures such as exercise, risk factor modification, and pharmacological therapy, as well as surgical treatment, which includes interventional radiological procedures such as angioplasty or stent insertion and surgical treatment such as endarterectomy, bypass grafting, and amputation.
Therapeutic angiogenesis by cell transplantation is another promising therapy. Recently, we have reported the effectiveness and safety of therapeutic angiogenesis by transplantation of autologous bone marrow mononuclear cells (BM-MNCs) to ischemic limbs, because of the natural ability of bone marrow cells to supply endothelial progenitor cells and secrete various angiogenic factors or cytokines. Autologous transplantation of BM-MNCs represents a new and promising strategy for clinical application designed to revascularize ischemic tissues.
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