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Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
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Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia

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Improvement in systemic endothelial condition following amputation in patients with critical limb ischemia

D J Newton1, F Khan, G Kennedy

  • 1Vascular Diseases Research Unit, The Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, UK. d.j.newton@dundee.ac.uk

International Angiology : a Journal of the International Union of Angiology
|November 1, 2008
PubMed

Insights

Amputating ischemic limbs in critical limb ischemia (CLI) patients significantly reduced markers of endothelial dysfunction, including vascular endothelial growth factor (VEGF) and von Willebrand factor (vWF). This suggests peripheral tissue removal improves systemic vascular health.

Area of Science:

  • Vascular Biology
  • Cardiovascular Disease
  • Limb Ischemia Research

Background:

  • Critical limb ischemia (CLI) patients often have co-existing coronary heart disease, leading to high mortality.
  • Peripheral ischemic tissue may release toxins, worsening systemic endothelial function and atherosclerosis.
  • Investigating the impact of removing ischemic tissue on endothelial markers is crucial.

Purpose of the Study:

  • To determine if markers of endothelial function improve after amputation of an ischemic limb in CLI patients.
  • To assess the systemic effects of peripheral ischemic tissue on vascular endothelium.

Main Methods:

  • Measured blood levels of VEGF, homocysteine, endothelin-1, VCAM-1, E-selectin, thrombomodulin, and vWF in 40 CLI patients.
  • Assessed peripheral microvascular function using iontophoresis.
  • Repeated measurements 6 months post-amputation.

Main Results:

  • Patients with CLI exhibited elevated levels of endothelial products.
  • Six months after amputation, vascular endothelial growth factor (VEGF) decreased by 70% (P<0.01).
  • Six months after amputation, von Willebrand factor (vWF) decreased by 40% (P<0.01).

Conclusions:

  • Reduced VEGF and vWF levels post-amputation support the hypothesis of systemic effects from peripheral ischemic tissue.
  • Peripheral ischemic tissue may contribute to the progression of coronary heart disease in CLI patients.
  • Amputation may improve systemic vascular health by removing a source of endothelial toxins.
Abstract

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