| [ Summary ] |
This paper discusses diagnosis, of operative indications and strategies for bone marrow stem cell transplantation, and gene therapy for dialysis patients with lower limb ischemia, due to arteriosclerosis obliterans (ASO). Since ASO or diabetic atherosclerosis (DA) is often associated with ischemic heart disease and/or intra-or extra-cranial carotid artery stenosis, preoperative screening is critical. If any of these significant lesions are identified, carotid artery reconstruction, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting is performed, prior to lower limb artery bypass surgery, which is the second stage treatment. DA is characterized by multisegmental occlusion in crural arteries, medial calcification of small caliber arteries and microcirculatory disorders. The incidence of foot gangrene is also very high. Arteriography is fundamental to diagnosis, and bypasses below the ankle, using autologous vein grafts are required to salvage feet. In the case of extended foot gangrene, a skin graft or a musculocutaneous flap, combined with a bypass, is used to salvage feet. If patients with critical limb ischemia have no graftable distal arteries, angiogenesis therapy, such as bone marrow stem cell or peripheral blood mononuclear cell transplantation or gene therapy using plasmids may be indicated. However, further clinical studies are required because of lack of evidence concerning definitive efficacy. |