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(Circulation. 1995;91:2687-2692.)
© 1995 American Heart Association, Inc.

Articles

Arterial Gene Therapy for Therapeutic Angiogenesis in Patients With Peripheral Artery Disease

Jeffrey M. Isner, MD, Principal Investigator; Kenneth Walsh, PhD, Co–Principal Investigator; James Symes, MD; Ann Pieczek, RN; Satoshi Takeshita, MD; Jason Lowry, BS; Susan Rossow, BS; Kenneth Rosenfield, MD; Lawrence Weir, PhD; Edi Brogi, MD; Robert Schainfeld, DO

From St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Mass.

Correspondence to Jeffrey M. Isner, MD, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135. E-mail jisner@opal.tufts.edu.

Key Words: genes • angiogenesis • peripheral vascular disease

	Background

 
Peripheral Artery Disease: Primary Pharmacological Therapy Is Ineffective for Patients With Critical Limb Ischemia
The prognosis for patients with chronic critical leg ischemia, ie, rest pain and/or established lesions that jeopardize the integrity of the lower limbs, is often poor. Psychological testing of such patients has typically disclosed quality-of-life indexes similar to those of patients with cancer in critical or even terminal phases of their illness.¹ It has been estimated that in toto,² 150 000 patients per year require lower-limb amputations for ischemic disease in the United States. Their prognosis after amputation is even worse³ : the perioperative mortality for below-knee amputation in most series is 5% to 10% and for above-knee amputation 15% to 20%. Even when they survive, nearly 40% will have died within 2 years of their first major amputation; a major amputation is required in 30% of cases; and full mobility is achieved in only 50% of below-knee and 25% of above-knee amputees.

These grim statistics are compounded by the lack of efficacious drug therapy. As concluded in the Consensus Document of the European Working Group on Critical Leg Ischemia,³ ". . .there presently is inadequate evidence from published studies to support the routine use of primary pharmacological treatment in patients with critical leg ischemia. . . ." Evidence for the utility of medical therapy in the treatment of claudication is no better.^{4 5} Consequently, the need for alternative treatment strategies in such patients is compelling.

Therapeutic Angiogenesis Is a Novel Strategy for the Treatment of Critical Limb Ischemia
The therapeutic implications of angiogenic growth factors were identified by the pioneering work of Folkman⁶ and other workers more than two decades ago. Beginning a . . . [Full Text of this Article]

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