Angiogenesis for the treatment of vascular diseases

Critical ischemia of the limbs or myocardium is frequently accompanied by d iffuse distal vascular disease making it unapproachable by conventional rev ascularization techniques. Pharmacological treatment is available for coron ary artery disease but there has been no effective medical therapy for adva nced ischemia of the limbs. In the search for alternative treatments for pa tients with diffuse distal disease, recent developments in vascular biology have directed attention towards use of Vascular growth factors. Therapeuti c angiogenesis has shown promising results in early clinical studies as sho wn by improved clinical status and in some cases angiographic studies. We e mployed an angiogenic strategy that utilizes enhanced vascular endothelial growth factor (VEGF) in a fibrin network, in two patients with critical lim b ischemia. Objectively, we were able to demonstrate angiographically the g rowth of new blood vessels after administration of VEGF and fibrin composit e. Fibrin glue provides for the slow release of and prolongs the availabili ty of VEGF, thereby sustaining angiogenesis resulting in improved oxygenati on of ischemic tissue. Further investigations are warranted to validate if angiogenesis may increase blood flow in patients with advanced vascular dis ease.