Critical Limb Ischemia: Nothing To Give at the Office?
Authors: Robert M. Schainfeld
Journal: Annals of Internal Medicine (1999)

Editorials2 March 1999Critical Limb Ischemia: Nothing To Give at the Office?Robert M. Schainfeld, DO and Jeffrey M. Isner, MDRobert M. Schainfeld, DOSt. Elizabeth's Medical Center; Boston, MA 02135 (Schainfeld)St. Elizabeth's Medical Center; Boston, MA 02135 (Isner) and Jeffrey M. Isner, MDSt. Elizabeth's Medical Center; Boston, MA 02135 (Schainfeld)St. Elizabeth's Medical Center; Boston, MA 02135 (Isner)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-5-199903020-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The prognosis for patients with chronic critical leg ischemia—that is, pain at rest or established lesions that jeopardize the integrity of the lower limbs—is often poor (1). Psychological testing of such patients has typically disclosed quality-of-life indices similar to those of patients with cancer in critical or even terminal phases (2). It has been estimated that 150 000 patients require lower-limb amputation for critical leg ischemia in the United States annually (3). The prognosis after amputation is even worse (4): In most series, the perioperative mortality is 5% to 10% for below-the-knee amputation and 15% to 20% for above-the-knee amputation. ...References1. Isner JM, Rosenfield K. Redefining the treatment of peripheral artery disease. Role of percutaneous revascularization. Circulation. 1993;88:1534-57. CrossrefMedlineGoogle Scholar2. Albers M, Fratezi AC, De Luccia N. Assessment of quality of life of patients with severe ischemia as a result of infrainguinal arterial occlusive disease. J Vasc Surg. 1992;16(1):54-9. CrossrefGoogle Scholar3. Dormandy JA, Thomas PR. What is the natural history of a critically ischemic patient with and without his leg? In: Greenhalgh RM, Jamieson C, Nicolaides AN, eds. Limb Salvage and Amputation for Vascular Disease. 11th ed. Philadelphia: WB Saunders; 1988:11-26. 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Vascular endothelial growth factor/vascular permeability factor enhances vascular permeability via nitric oxide and prostacyclin. Circulation. 1998;97:99-107. CrossrefMedlineGoogle Scholar14. Olin JW, Young JR, Graor RA, Ruschhaupt WF, Bartholomew JR. The changing clinical spectrum of thromboangiitis obliterans (Buerger's disease). Circulation. 1990;82 5 Suppl IV3-8. MedlineGoogle Scholar15. Isner JM, Baumgartner I, Rauh G, Schainfeld R, Blair R, Manor O, et al . Treatment of thromboangiitis obliterans (Buerger's disease) by intramuscular gene transfer of vascular endothelial growth factor: preliminary clinical results. J Vasc Surg. 1998;28:964-75. CrossrefMedlineGoogle Scholar16. Losordo DW, Vale PR, Symes JF, Dunnington CH, Esakof DD, Maysky M, et al . Gene therapy for myocardial angiogenesis: initial clinical results with direct myocardial injection of phVEGF165 as sole therapy for myocardial ischemia. Circulation. 1998;98:2800-4. CrossrefMedlineGoogle Scholar17. Rivard A, Fabre JE, Silver M, Chen D, Murohara T, Kearney M, et al . Age-dependent impairment of angiogenesis. Circulation. 1999;99:111-20. CrossrefMedlineGoogle Scholar18. Couffinhal T, Silver M, Kearney M, Sullivan A, Isner JM. Angiogenesis is impaired in ApoE knockout mice due to reduced expression of vascular endothelial growth factor [Abstract]. Circulation. 1996;94:I-102. MedlineGoogle Scholar19. Rivard A, Silver M, Chen D, Kearney M, Magner M, Annex B, et al. Rescue of diabetes related impairment of angiogenesis by intramuscular gene therapy with adeno-VEGF. Am J Pathol. [In press]. Google Scholar Author, Article, and Disclosure InformationAffiliations: St. Elizabeth's Medical Center; Boston, MA 02135 (Schainfeld)St. Elizabeth's Medical Center; Boston, MA 02135 (Isner)Corresponding Author: Jeffrey M. Isner, MD, St. Elizabeth's Medical Center, 736 Cambridge Street, Boston, MA 02135.Current Author Addresses: Drs. Schainfeld and Isner: St. Elizabeth's Medical Center, 736 Cambridge Street, Boston, MA 02135. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoProstanoids for Chronic Critical Leg Ischemia Metrics Cited byTetragonia tetragonoides (Pall.) 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Isner, MDTherapeutic Angiogenesis for Ischemic Cardiovascular DiseaseLeakage-Resistant Blood Vessels in Mice Transgenically Overexpressing Angiopoietin-1 2 March 1999Volume 130, Issue 5Page: 442-444KeywordsAngiogenesisDrug therapyGene transferIschemiaLesionsProstaglandinProstanoidSurgeryUlcersVascular endothelial growth factor Issue Published: 2 March 1999 Copyright & PermissionsCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...