[Inducing collaterals in due time. Arteriogenesis as a preventive principle]

A stimulation of collateral vessel growth is an attractive alternative therapeutic tool especially for patients with diffuse occlusive vessel disease. Extensive in vivo and in vitro studies in the preceding decades have led us to a thorough understanding of basic arteriogenic principles. Due to the timeline of naturally occurring arteriogenesis, a well-timed therapeutic induction appears to be limiting for effective proarteriogenic therapies in high-risk patients. Potential therapeutic approaches are based on a stimulation of monocyte function through cytokine application. First clinical studies have, nevertheless, demonstrated the limits of a unifactorial therapy. Therefore, a stimulation of the mechanical inductor of arteriogenic proliferation, i. e. fluid shear stress acting on the arteriolar endothelium, appears as a feasible therapeutic addition. Current results show the feasibility of that principle not only through active physical training, but also through passive application of an external counterpulsation (EECP), a method showing promising first results in the clinical setting.