[Medical treatment and therapeutic angiogenesis of critical limb ischemia]

The incidence of arteriosclerotic disease is increasing in Japan due to the aging of the population and the westernization of the diet. Peripheral arterial disease (PAD) presents with various clinical conditions. In particular, the management of patients with critical limb ischemia (CLI) such as pain at rest, ischemic ulcer, or gangrene in the lower extremities has been problematic and the treatment of these patients varies widely among countries. A surgical approach such as distal bypass using an autogenous saphenous vein is still the "gold standard" for the treatment of CLI. In addition, due to recent advances in endovascular technologies, catheter-based intervention has become a viable option, and percutaneous treatment is becoming more widely used. However, the surgical approach is not indicated for some patients with PAD. Recently, therapeutic neovascularization has been suggested as new strategy for patients with CLI. This strategy is mainly classified into two types of therapy, gene therapy and cell therapy, both of which aim to promote the development of collateral vessels in the ischemic lesions. In the present report, we discuss the current status of the medical treatment of CLI, including therapeutic angiogenesis.