Therapeutic Angiogenesis in Peripheral Artery Disease

Periperal artery disease (PAD) is caused by occlusion of lower limb arteries, leading to poor irrigation (ischemia) of tissues, which can lead to amputation. When PAD progresses to critical limb threatening ischemia (CLTI), the only treatment is surgical revascularization.

Unfortunately, 20 to 40% of CLTI patients are not amenable to revascularization or have failed revascularization. Moreover, vascular surgery carries one of the highest rates of perioperative events, and about 20% of vascular surgery patients show signs of cardiac injury and associated risk of mortality. Finally, all surgical revascularization suffer from high failure rates due to intimal hyperplasia (IH), a process whereby a “neointima” layer is formed between the internal elastic lamina and the endothelium.

Against this background, patients with limited surigcal options could benefit from therapeutic angiogenesis or arteriogenesis to promote the formation or natural bypasses.