Stem cells as a new treatment for peripheral artery disease: hype or hope? The point of view of a vascular surgeon.

Because many of patients with peripheral arterial disease are not eligible for direct or conventional revascularization procedures, because stem cell therapy is being investigated as to its possible role in the treatment of limb ischemia, there is a need to evaluate this treatment and his true application. On the basis of experimental data, preliminary clinical studies have established the safety and feasibility of stem cells implantation in case of critical limb ischemia. Forthcoming large studies, especially randomized placebo controlled double blind studies, related to the optimal cell type, dosage, administration route, will consolidate this evidence and establish mid and long term effectiveness.

[Stenting in superficial femoral artery and usCRP: Multicentric study SAFE in 255 patients]. / Stenting de l'artère fémorale superficielle et C-Reactive Protein ultrasensible (CRPus) : étude multicentrique SAFE de 255 patients.

OBJECTIVE: To evaluate mid-term primary patency of the femoral artery stenting in correlation with usCRP level and characteristics of the population, morphological aspect of the lesions and interventional techniques. METHODS: Patients were prospectively included in a multicenter study (18 centers in France) after stenting (SMART, Cordis Johnson & Johnson, Issy-les-Moulineaux, France) of the superficial femoral artery (SFA). Inclusion and exclusion criteria were based on recommendations and every day practice of the centers. RESULTS: Thus 255 patients (183 men; mean age: 69 years; range 44-92) were included. Technical success of the SFA stenting was 100% without any complications and primary angiographic success 97%. usCRP level increased significantly (p < 0.05) between before and 24h after SFA stenting. In the subgroup of patients without initial inflammation (n = 157), usCRP increased significantly (p < 0.05) in the group of patient with initial thrombosis and additional intervention (graft, amputation, angioplasty on other arterial bed) in the same procedure compared to the remaining patients. Restenosis rate was 12.4% (26/209 patients) at 7 ± 2 months. Before stenting, usCRP level was not predictive of a restenosis, whereas after stenting, an increase of the 24h usCRP level was significantly higher in the subgroup of patient with an occlusion at mid-term (8 patients; p < 0.05). CONCLUSION: This study demonstrated good patency at 7 months of SFA stenting with nitinol SMART with an increase of the usCRP level 24h after stenting in favour of the presence of an occlusion at mid-term follow-up.

Rheological properties of healthy and atherosclerotic human arteries.

The aim of this study was to determine the comparative three-dimensional mechanical properties of healthy and atherosclerotic muscular human arteries. Using a previously developed experimental system, in vitro inflation tests were performed on twelve segments of arteries, in static conditions. Two different initial states were used to carry the mechanical study through (large deformation, thick-walled). Main significant differences between healthy and atherosclerotic tested segments are observed for axial traction force whatever the initial state and radial and circumferencial strains referenced to longitudinally pre-stretched state. We showed that strain energy allows to differentiate between both types of arteries only when absolute values of transversal components were considered. Differential values of energy were not discriminating. Our results also show the potential interest of studying arteries in vivo at low transmural pressure.