Autologous Adipose-derived Stromal Stem Cell Implantation to Resolve Critical Limb Ischemia: Case Report

Juan J Parcero,Thomas Ichim,Carlos Castañeda,Silvia Gonzalez,Sharon Mcquillan,Kristin Comella,Mariano A Lopez-Diaz,Jesus A Perez,Jose Limon,Javier Lopez,Amit N Patel

doi:10.7759/cureus.182

Abstract

Critical limb ischemia (CLI) is a debilitating condition for which limited therapeutic options exist. Characterized by ischemia of the lower limb due to vascular deficiency, attempts have been made to stimulate angiogenesis utilizing cell and gene-based approaches. Adipose stromal vascular fraction (SVF) cells are a practical source of autologous tissue that can be prepared inexpensively in a same-day procedure. Recent studies have demonstrated SVF to be highly angiogenic, as well as clinically safe in a variety of contexts. Here, we describe the rationale and, to our knowledge, the first successful clinical implementation of autologous SVF cells for the treatment of a no-option CLI patient.

Highlights

Peripheral vascular disease commonly affects the arteries supplying the lower extremities and is the most common cause of atherosclerotic disease
Adipose stromal vascular fraction (SVF) cells are a practical source of autologous tissue that can be prepared inexpensively in a same-day procedure
In the majority of cases, peripheral artery disease is caused by atherosclerotic occlusion, radiation therapy-associated vasculopathy has been reported [1]

Summary

Introduction

Peripheral vascular disease commonly affects the arteries supplying the lower extremities and is the most common cause of atherosclerotic disease. In the majority of cases, peripheral artery disease is caused by atherosclerotic occlusion, radiation therapy-associated vasculopathy has been reported [1]. Regardless of the etiology, restriction of blood supply to the affected limb results in ischemia. This will usually manifest as pain when walking (intermittent claudication), limitation in the patient's functional class, and as the ischemic process progresses, pain at rest, ulceration, infection, and eventually gangrene. Advanced peripheral arterial disease is termed critical limb ischemia (CLI). In CLI patients, loss of limb can occur when the ischemia is not resolved by either percutaneous or surgical revascularization procedures [2,3]. Rehabilitation is a long and difficult process with extremely high health care costs [4]

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