title: Non-reconstructable peripheral vascular disease of the lower extremity in ten patients treated with adipose-derived stromal vascular fraction cells.
abstract: We present a series of ten patients with non-reconstructable peripheral vascular disease (PVD), secondary to arteriosclerosis (AS) and/or diabetes mellitus (DM), treated with local injection of non-expanded autologous, adipose-derived stromal vascular fraction (SVF) cells for the purposes of enhancing neovascularization and chronic wound healing. Adipose tissue was surgically harvested and processed to yield the heterogeneous SVF cells for immediate point-of-care injection. The gastrocnemius muscles and ulcers or wounds where present were locally injected with the resulting SVF. Response to treatment was evaluated both clinically based on pain-free ambulation, wound healing capacity over time and ankle/brachial index (ABI) measurements, and by imaging using MRI-based angiography. All patients exhibited clinical improvement (reduction in rest pain and claudication and improvements in ABI), with imaging signs of neovascularization in the majority (5 of 6) of patients in whom the evaluation was feasible. Similarly, 5 of 6 chronic wounds healed without further surgical intervention. This series highlights the utility of non-expanded adipose-derived heterogeneous SVF cell population processed at the point-of-care, to treat patients with end-stage PVD as an alternative to palliation or amputation.
authors.affiliation: Division of Plastic Surgery, Hospital Metropolitano Vivian Pellas, Managua, Nicaragua; Division of Plastic Surgery, Saint Louis University, USA; Department of Plastic Surgery, Universidad Nacional Autónoma de Nicaragua, Leon, Nicaragua. Electronic address: michaelcarstens@mac.com.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Carstens
authors.affiliation: Division of Plastic Surgery, Hospital Metropolitano Vivian Pellas, Managua, Nicaragua; Department of Plastic Surgery, Universidad Nacional Autónoma de Nicaragua, Leon, Nicaragua.
authors.forename: Arturo
authors.initials: A
authors.lastname: Gómez
authors.affiliation: Department of Vascular Surgery, Universidad Nacional Autónoma de Nicaragua, Leon, Nicaragua.
authors.forename: Ronald
authors.initials: R
authors.lastname: Cortés
authors.affiliation: Intensive Care Unit, University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Turner
authors.affiliation: Department of Radiology, Hospital Metropolitano Vivian Pellas, Managua, Nicaragua.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pérez
authors.affiliation: Department of Surgery, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua.
authors.forename: Marlon
authors.initials: M
authors.lastname: Ocon
authors.affiliation: Department of Orthopedics, Division of Sports Medicine, University of Miami, Miller School of Medicine, Miami, Miami, FL, USA; Diabetes Research Institute and Cell Transplant Center, University of Miami, Miller School of Medicine, Miami, Miami, FL, USA. Electronic address: dxc821@med.miami.edu.
authors.forename: Diego
authors.initials: D
authors.lastname: Correa
mesh_terms: D000273:Adipose Tissue / Q000166:cytology*; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D055109:Ankle Brachial Index; D001161:Arteriosclerosis / Q000150:complications; D002478:Cells, Cultured; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D059408:Pain Management; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000473:pathology / Q000628:therapy*; D017154:Stromal Cells / Q000166:cytology / Q000378:metabolism / Q000637:transplantation*; D014182:Transplantation, Autologous; D014945:Wound Healing
keywords: Arteriosclerosis; Cell therapy; Diabetes; Neovascularization; Peripheral vascular disease; Stromal vascular fraction