ABSTRACT
BACKGROUND: Peripheral arterial disease remains a significant global health burden despite revolutionary improvements in endovascular techniques over the past decade. The durability of intervention for critical limb ischaemia is poor, and the condition is associated with high morbidity and mortality rates. To address this deficiency, alternative therapeutic options are being explored. Advances in the fields of gene therapy and therapeutic angiogenesis have led to these being advocated as potential future treatments. METHODS: Relevant medical literature from PubMed, Embase, the Cochrane Library and Google Scholar from the inception of these databases to June 2011 was reviewed. RESULTS: Encouraging outcomes in preclinical trials using a variety of proangiogenic growth factors have led to numerous efficacy and safety studies. However, no clinical study has shown significant benefit for gene therapy over placebo. CONCLUSION: Identifying the optimal site for gene delivery, choice of vector and duration of treatment is needed if gene therapy is to become a credible therapeutic option for peripheral arterial disease.
Subject(s)
Genetic Therapy , Neovascularization, Physiologic/drug effects , Peripheral Arterial Disease/genetics , Peripheral Arterial Disease/therapy , Calcium-Binding Proteins , Carrier Proteins/genetics , Carrier Proteins/metabolism , Cell Adhesion Molecules , Controlled Clinical Trials as Topic , Fibroblast Growth Factors/genetics , Fibroblast Growth Factors/metabolism , Genetic Therapy/methods , Genetic Vectors , Hepatocyte Growth Factor/genetics , Hepatocyte Growth Factor/metabolism , Humans , Hypoxia-Inducible Factor 1, alpha Subunit/genetics , Hypoxia-Inducible Factor 1, alpha Subunit/metabolism , Neovascularization, Physiologic/genetics , Plasmids , Research Design , Vascular Endothelial Growth Factor A/genetics , Vascular Endothelial Growth Factor A/metabolism , VirusesABSTRACT
A cyclist reported gradual onset, bilateral leg claudication without any atherosclerotic risk factors and with a normal vascular examination. Duplex ultrasound and magnetic resonance angiography revealed bilateral focal stenoses due to coralline plaques of the common femoral arteries (CFAs) but normal proximal and distal vasculature. A surgical endarterectomy with vein patch angioplasty resolved all symptoms. Cyclist's iliac syndrome (whereby mechanical and anatomical factors in competitive cyclists and runners lead to arterial kinking and subsequent intimal hyperplasia, endofibrosis and, ultimately, stenoses of the external iliac arteries) is well documented. This is the first report to our knowledge of a similar process isolated to the CFA.
