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{\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;11\\\/15\\\/28\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;11\\\/15\\\/28\u0022}],\u0022ac\u0022:{\u0022spmdc;11\\\/15\\\/28\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;11\\\/15\\\/28\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPeripheral artery disease (PAD) symptom severity is best described as a functional problem (walking speed and distance, oxygen consumption, level of physical activity, and quality of life). This article discusses claudication therapy, critical limb ischemia, revascularization strategies, treatment options for PAD, and a cost analysis of this disease.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPeripheral artery disease (PAD) symptom severity is best described as a functional problem (walking speed and distance, oxygen consumption, level of physical activity, and quality of life; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). William Hiatt, MD, University of Colorado, Aurora, Colorado, USA, gave an overview of the current state of claudication therapy. Dr. Hiatt noted that while exercise in a supervised setting and in selected patients is effective, the results may not be generalizable, and clear clinical benefit in a broad community setting is lacking. Several therapeutic approaches, such as lipid modulation, antibiotic therapy, and gene therapy, have been tried but were unsuccessful; however, PDE-3 inhibitors have shown modest efficacy. A meta-analysis of nine randomized, controlled trials that used the PDE-3 inhibitor cilostazol to treat claudication in patients showed that cilostazol was associated with a 50.7% improvement from baseline in mean walking distance versus placebo (24.3%). The absolute improvement was 42.1 meters greater than the improvement with placebo (p\u0026lt;0.001) over a mean follow-up period of 20.4 weeks. Continued increases were demonstrated over the 24-week treatment period. Improvements in pain-free walking distance were demonstrable as well [Pande RI et al. \u003Cem\u003EVasc Med\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11692\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11692\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11692\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-3\u0022 class=\u0022first-child\u0022\u003EPAD Symptom Severity.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EThe overall prevalence of PAD in the United States has been estimated at 7.2% [Allison MA et al. \u003Cem\u003EAm J Prev Med\u003C\/em\u003E 2007]. This translates to about 8.5 million Americans, or roughly one in 16 individuals over the age of 40 years. The risks are significantly greater for African-Americans and Hispanics. Susan Duval, PhD, University of Minnesota, Minneapolis, Minnesota, USA, discussed a \u2018nomogram\u2019 that she and her colleagues have developed for estimating PAD probability. The system is based on data from the REACH Registry and is based on age, sex, race, diabetes status, body mass index, hypertension status, smoking status, and coronary artery disease, cardiovascular disease, and congestive heart failure status. Although the scientific knowledge exists to diagnose, treat, and even prevent PAD, awareness of PAD remains low.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EPAD is also expensive. Mean cumulative hospitalization costs, per patient, are estimated to be $7445, $7000, $10,430, and $11,693 for patients with asymptomatic PAD, a history of claudication, lower limb amputation, and revascularization, respectively (p=0.007) [Mahoney EM et al. \u003Cem\u003ECirc Cardiovasc Qual Outcomes\u003C\/em\u003E 2010]. It is estimated that the total annual costs that are associated with vascular hospitalization in PAD patients exceed $21 billion (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Hirsch At et al. \u003Cem\u003ECir Cardiovasc Qual Outcomes\u003C\/em\u003E 2008]. It is suspected that a significant number of patients with PAD remain undiagnosed. In addition, in patients with PAD, there is underutilization of proven secondary prevention therapies [Pande RL et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022One- and Cumulative 2-Year Costs Associated With Hospitalizations for Vascular Reasons, per Patient, by Baseline PAD Class.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-786283317\u0022 data-figure-caption=\u0022One- and Cumulative 2-Year Costs Associated With Hospitalizations for Vascular Reasons, per Patient, by Baseline PAD Class.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11689\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EOne- and Cumulative 2-Year Costs Associated With Hospitalizations for Vascular Reasons, per Patient, by Baseline PAD Class.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECopyright \u00a9 2011 American Heart Association. All rights reserved.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003ECritical limb ischemia (CLI) is defined as ischemia rest pain or tissue loss and compromised leg hemodynamics and has a high amputation and mortality rate. Therapies are limited, and no proven treatment targets have been identified. Michael S. Conte, MD, Brigham and Women\u0027s, Boston, Massachusetts, USA, discussed the significant issues that are associated with diagnosis and management of CLI.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ERevascularization is effective for wound healing, functional limb preservation, and pain relief. One small study in a highly selected group of diabetic patients with CLI reported that revascularization allows the postponement of major amputation and improves survival rates compared with nonrevascularized amputated patients (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [Faglia E. \u003Cem\u003EJ Diab Comp\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022CLI: A Selective Revascularization Strategy.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-786283317\u0022 data-figure-caption=\u0022CLI: A Selective Revascularization Strategy.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11690\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003ECLI: A Selective Revascularization Strategy.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from MS Conte, MD\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EA relatively new and evolving approach is endovascular therapy for limb salvage. It offers the potential advantages of being less invasive with faster recoveries; however, data that have evaluated outcomes with this therapy are mixed. Disadvantages include reduced efficacy compared with existing therapy in terms of hemodynamics and durability, risk of limb deterioration, possible effect on surgical options, and increased treatment cost due to the need for repeat treatments. A meta-analysis of studies in infrapopliteal angioplasty compared with bypass surgery for chronic CLI showed limited technical success and durability with angioplasty but comparable limb salvage rates [Romiti M et al. \u003Cem\u003EJ Vasc Surg\u003C\/em\u003E 2008]. However, another study [Vogel TR et al. \u003Cem\u003EJ Vasc Surg\u003C\/em\u003E 2011] reported higher rates of in-hospital complications, rehospitalization, and amputations with angioplasty. A third study reported slightly lower mortality rates and increased costs with angioplasty treatment [Sachs T et al. \u003Cem\u003EJ Vasc Surg\u003C\/em\u003E 2011]. Longitudinal studies are recommended to determine the appropriateness of angioplasty in both claudication and limb-threatened patients.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003ESurgical bypass of peripheral arterial occlusive disease with autologous vein grafts provides an effective means of restoring blood flow to the lower extremity and has been a standard therapy for patients with disabling claudication or CLI. However, failure rates may run as high as 50% within 5 years. Further, prior failed endovascular interventions in patients with CLI predict poor outcomes after lower extremity bypass. Dr. Conti predicts that centers for amputation prevention will focus on high-risk patients and provide coordinated inpatient and outpatient management. They will offer a multidisciplinary team approach, with vascular surgery and podiatry being key players.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003ETreatment options for symptomatic PAD are limited, and while medical therapies may help to modify the underlying disease, there are no approved medical (nonrevascularization) therapies to increase blood flow to the ischemic limb. Brian Annex, MD, University of Virginia, Charlottesville, Virginia, USA, discussed genetic and cell-based studies that aim to improve limb perfusion in patients with PAD.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EIn a 2008 study that comprised 104 patients with CLI, Powell and colleagues demonstrated that intramuscular injection of high doses (4.0 mg at Days 0, 14, and 28) of hepatocyte growth factor (HGF) plasmid was safe and led to significant increases in transcutaneous oxygen tension (TcPo2; 24.0\u00b14.2 mm Hg) compared with placebo (9.4\u00b1 4.2 mm Hg), low dose (0.4 mg at Days 0, 14, and 28; 11.7\u00b1 3.7 mm Hg), and middle dose (4.0 mg at Days 0 and 28; 7.3\u00b14.8 mm Hg) HGF plasmid (ANCOVA p=0.0015) [Powell RJ et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2008]. Recently, the same group showed that this therapy can also improve toe brachial index (0.05\u00b10.05 vs \u22120.17\u00b10.04 for placebo; p=0.047) and rest pain, as assessed using a 10-cm visual analog scale (VAS; \u22121.9\u00b11.3 vs +0.06\u00b10.2 for placebo; p=0.04) [Powell R et al. \u003Cem\u003EJ Vasc Surg\u003C\/em\u003E 2010]. Early bone marrow studies showed that autologous implantation of bone marrow mononuclear cells in patients with PAD-induced ischemia produced improvements in ankle brachial index, transcutaneous oxygen pressure, rest pain, and pain-free walking time [Tateishi-Yuyama E et al. \u003Cem\u003ELancet\u003C\/em\u003E 2002]. More recently, Powell and colleagues evaluated patients with CLI and showed that injection of tissue repair cells led to improvements in time to treatment failure, defined as amputation-free survival, increase in wound size, and new gangrene (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E) [Powell et al. \u003Cem\u003EJ Vasc Surg\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Time to First Occurrence of Treatment Failure (ITT Population- All Patients).\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-786283317\u0022 data-figure-caption=\u0022Time to First Occurrence of Treatment Failure (ITT Population- All Patients).\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 3.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 3.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/15\/28\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11691\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 3.\u003C\/span\u003E \n            \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003ETime to First Occurrence of Treatment Failure (ITT Population- All Patients).\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EReprinted from the \u003Cem\u003EJournal of Vascular Surgery\u003C\/em\u003E, Vol. 54, Issue 4, Pages 1032\u20131041, Powell RJ et al, Interim analysis results from the RESTORE-CLI, a randomized, double-blind, multicenter phase II trial comparing expanded autologous bone marrow-derived tissue repair cells and placebo in patients with critical limb ischemia, Copyright 2011, with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-16\u0022\u003EA recent CLI study used autologous therapy with bone marrow-derived aldehyde dehydrogenase bright cells [Perin EC et al. \u003Cem\u003ECath Card Int\u003C\/em\u003E 2011] and another recently completed clinical trial evaluated the use of autologous CD34+ cells for CLI [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00616980\u0026amp;atom=%2Fspmdc%2F11%2F15%2F28.atom\u0022\u003ENCT00616980\u003C\/a\u003E]. While these early studies show promise for the development of noninterventional therapies to improve limb perfusion, further studies are required to determine whether they are useful in current clinical care.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/15\/28.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmvre\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmvre\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmvre\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}