Endovascular Repair of an Iliac Arteriovenous Fistula in a 30-Year-Old Female Patient with Suspected Severe Cardiac Insufficiency: A Case Report.

A 30-year-old female was initially diagnosed with cardiac insufficiency and severe claudication. Additional imaging revealed a large iliac arteriovenous fistula, which was treated with an endovascular technique. A custom-made, self-expanding, polytetrafluorethylene-covered stent was implanted to restore the physiologic hemodynamic environment. The patient was asymptomatic at the 12-month clinical follow-up.

Vascular-endothelial growth factor (VEGF) in patients with peripheral ischemia.

Vascular endothelial growth factor (VEGF) is a key cytokine responsible for the spontaneous new blood vessel formation in the course of peripheral ischemia. It has repeatedly been observed in patients with critical leg ischemia that their clinical status does not reflect any effective local neovascularization processes as well as VEGF system up-regulation. Therefore, the aim of present study was to compare the proangiogenic status, assessed as the serum VEGF concentration, in patients with mild, moderate, and severe peripheral ischemia and to analyze to what extend it is influenced by the therapy applied. Serum VEGF level was evaluated by ELISA method in 31 patients with peripheral ischemia at different time points throughout the treatment. On Day 0 (before treatment), Day 2, and Day 7, VEGF concentration was significantly higher in subjects with critical leg ischemia (Group I) than in other groups (P<0.001). In Group I, VEGF decline was reported on Day 30 following radical surgery, while in a group of moderate disease treated by revascularization surgery a significant increase in serum VEGF concentration was observed (Day 7 and Day 30) (P=0.02). Serum cytokine level in the patients with mild ischemia (Group III) on pharmacotherapy was stable throughout the observation period. Interestingly, the increase in VEGF levels throughout the study period from Day 0 to Day 30 was significantly greater in unsuccessfully treated patients compared with subjects who positively responded to therapy or did not show any response at all. We conclude that mechanisms other than hypoxia might drive the observed up-regulation of VEGF production in peripheral ischemia.

Angiogenic and antiangiogenic gene therapy.

Gene therapy is thought to be a promising method for the treatment of various diseases. One gene therapy strategy involves the manipulations on a process of formation of new vessels, commonly defined as angiogenesis. Angiogenic and antiangiogenic gene therapy is a new therapeutic approach to the treatment of cardiovascular and cancer patients, respectively. So far, preclinical and clinical studies are successfully focused mainly on the treatment of coronary artery and peripheral artery diseases. Plasmid vectors are often used in preparations in angiogenic gene therapy trials. The naked plasmid DNA effectively transfects the skeletal muscles or heart and successfully expresses angiogenic genes that are the result of new vessel formation and the improvement of the clinical state of patients. The clinical preliminary data, although very encouraging, need to be well discussed and further study surely continued. It is really possible that further development of molecular biology methods and advances in gene delivery systems will cause therapeutic angiogenesis as well as antiangiogenic methods to become a supplemental or alternative option to the conventional methods of treatment of angiogenic diseases.