title: Low-energy extracorporeal shock wave therapy improves microcirculation blood flow of ischemic limbs in patients with peripheral arterial disease: pilot study.
abstract: BACKGROUND
  Because direct application of low-energy shock waves induces angiogenesis, we investigated the safety and efficacy of this new therapy to develop a noninvasive method of repeatable therapeutic angiogenesis for treating peripheral arterial disease (PAD).
  
  
  METHODS
  The subjects were 10 patients who had symptomatic PAD and limited ischemia in a below-the-knee artery. Low-energy shock waves were directly applied to the calf muscles 6 times every other day. Intracorporeal changes were evaluated with ultrasonography to determine adverse effects of therapy. To assess blood flow of the microcirculation, transcutaneous oxygen tension (TcPO2), skin perfusion pressure (SPP), and (99m)technetium-tetrofosmin ((99m)Tc-TF) scintigraphy were performed before and after therapy. The TcPO2 was measured while subjects inhaled pure oxygen (maximum TcPO2). The (99m)Tc-TF perfusion index was determined as a ratio of uptake in muscle to that in the brain (control) for quantitative analysis.
  
  
  RESULTS
  No adverse effects were noted in any patient. Maximum TcPO2 values increased significantly on the calf (57.3±28.4 to 71.0±14.5 mm Hg, p=0.044) and the dorsum of the foot (52.2±21.8 to 76.1±17.9 mm Hg, p=0.012). The SPP tended to increase after therapy on the dorsum and plantar surfaces of the foot, but the differences were not significant. The (99m)Tc-TF perfusion index in the foot significantly increased (0.48±0.09 to 0.61±0.12, p=0.0013), but that in the leg did not change.
  
  
  CONCLUSIONS
  We have demonstrated that low-energy shock wave therapy is safe and can restore blood flow in the microcirculation in patients with symptomatic PAD.
authors.affiliation: Division of Cardiology and Regenerative Medicine, Department of Internal Medicine, Nippon Medical School.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Tara
authors.forename: Masaaki
authors.initials: M
authors.lastname: Miyamoto
authors.forename: Gen
authors.initials: G
authors.lastname: Takagi
authors.forename: Sonoko
authors.initials: S
authors.lastname: Kirinoki-Ichikawa
authors.forename: Akito
authors.initials: A
authors.lastname: Tezuka
authors.forename: Tomohito
authors.initials: T
authors.lastname: Hada
authors.forename: Ikuyo
authors.initials: I
authors.lastname: Takagi
mesh_terms: D000368:Aged; D043925:Angiogenesis Inducing Agents; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D058729:Peripheral Arterial Disease / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D014464:Ultrasonic Therapy / Q000379:methods*
chemical_list: D043925:Angiogenesis Inducing Agents