Fibroblast growth factor as therapy for critical limb ischemia: a case report

In an attempt to avert impending, primary amputation, an 85-year-old woman with chronic critical leg ischemia was enrolled in an experimental protocol to induce therapeutic angiogenesis. Treatment consisted of six consecutive , weekly intravenous infusions of recombinant basic fibroblast growth facto r (bFGF). Angiographic evaluation was performed before and after therapy. T he patient's clinical response was monitored through serial measurements of the ankle/brachial index and by repetitive assessment of limb flow by merc ury strain-gauge plethysmography. A beneficial clinical response was detectable by week 4 of therapy, which w as characterized by an improved walking distance, relief of ischemic pain, a marked reduction in analgesic consumption, and healing of persistent, unr esponsive, painful inflammation of the hallux, The clinical improvement was sustained throughout the remaining weeks of therapy and follow-up evaluati on. Plethysmography documented improved blood flow; specifically, the augme ntation of digital flow was sustained and correlated with the marked improv ement in the patient's clinical status.