Limitations of Hyperbaric Oxygenation in Occlusive Arterial Disease

Gorman, James; Stansell, Gilbert; Douglass, Frederick M.

doi:10.1161/01.cir.32.6.936

Cited by 11 publications

(5 citation statements)

References 8 publications

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“…It is proposed that the underlying mechanism of HBO therapy that is predominantly involved in improving ischemic PAOD is the increase of vascular wall permeability and production of hypoxia-inducible factor (HIF)-1α and stromal cell-derived factor (SDF)-1α that enhance the angiogenesis, circulatory EPCs level and blood flow in the ischemic area [ 24 , 25 ]. Unsatisfactorily, the overall limb salvage and progression of the ischemic process have not been significantly decreased in patients receiving HBO therapy [ 26 ]. This may be due to the diffusion of oxygen into the ischemic organ that creates a hyperbaric environment being extremely limited [ 27 , 28 ] in severe PAOD patients.…”

Section: Introductionmentioning

confidence: 99%

“…Based on the aforementioned issues [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], we tested the hypothesis that treatment with EPCs derived from PAOD patients who received combined CD34 + cell and HBO therapy (defined as rejuvenated EPCs) would offer additional benefits than either one therapy alone for protecting limbs against the CLI procedure in nude mouse.…”

Section: Introductionmentioning

confidence: 99%

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Circulatory Rejuvenated EPCs Derived from PAOD Patients Treated by CD34+ Cells and Hyperbaric Oxygen Therapy Salvaged the Nude Mouse Limb against Critical Ischemia

Chen

Sheu

Chiang

et al. 2020

IJMS

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This study tested whether circulatory endothelial progenitor cells (EPCs) derived from peripheral arterial occlusive disease (PAOD) patients after receiving combined autologous CD34+ cell and hyperbaric oxygen (HBO) therapy (defined as rejuvenated EPCs) would salvage nude mouse limbs against critical limb ischemia (CLI). Adult-male nude mice (n = 40) were equally categorized into group 1 (sham-operated control), group 2 (CLI), group 3 (CLI-EPCs (6 × 105) derived from PAOD patient’s circulatory blood prior to CD34+ cell and HBO treatment (EPCPr-T) by intramuscular injection at 3 h after CLI induction) and group 4 (CLI-EPCs (6 × 105) derived from PAOD patient’s circulatory blood after CD34+ cell and HBO treatment (EPCAf-T) by the identical injection method). By 2, 7 and 14 days after the CLI procedure, the ischemic to normal blood flow (INBF) ratio was highest in group 1, lowest in group 2 and significantly lower in group 4 than in group 3 (p < 0.0001). The protein levels of endothelial functional integrity (CD31/von Willebrand factor (vWF)/endothelial nitric-oxide synthase (eNOS)) expressed a similar pattern to that of INBF. In contrast, apoptotic/mitochondrial-damaged (mitochondrial-Bax/caspase-3/PARP/cytosolic-cytochrome-C) biomarkers and fibrosis (Smad3/TGF-ß) exhibited an opposite pattern, whereas the protein expressions of anti-fibrosis (Smad1/5 and BMP-2) and mitochondrial integrity (mitochondrial-cytochrome-C) showed an identical pattern of INBF (all p < 0.0001). The protein expressions of angiogenesis biomarkers (VEGF/SDF-1α/HIF-1α) were progressively increased from groups 1 to 3 (all p < 0.0010). The number of small vessels and endothelial cell surface markers (CD31+/vWF+) in the CLI area displayed an identical pattern of INBF (all p < 0.0001). CLI automatic amputation was higher in group 2 than in other groups (all p < 0.001). In conclusion, EPCs from HBO-C34+ cell therapy significantly restored the blood flow and salvaged the CLI in nude mice.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Circulatory Rejuvenated EPCs Derived from PAOD Patients Treated by CD34+ Cells and Hyperbaric Oxygen Therapy Salvaged the Nude Mouse Limb against Critical Ischemia

Chen

Sheu

Chiang

et al. 2020

IJMS

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“…For these cases, additional conservative therapies such as lowdensity lipoprotein apheresis, hyperbaric oxygen therapy, or spinal cord stimulation should be adminiatered. [9][10][11][12][13][14] However, one problem with these therapies is their invasiveness. The ISDN-P therapy used in this study is noninvasive and has a high safety level, which is its most important feature.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 For these patients, additional conservative therapies, such as low-density lipoprotein apheresis, hyperbaric oxygen therapy, and spinal cord stimulation were administered. 9-14 However, they were not effective in several cases. In contrast, some reports indicated that nitrate patch is useful therapy for patients with PAD.…”

mentioning

confidence: 97%

The Efficacy of the Transdermal Isosorbide Dinitrate Patch in Patients With Chronic Limb-Threatening Ischemia

Matsui

Murakami

Hata

et al. 2020

The International Journal of Lower Extremity Wounds

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Recently, the number of patients with peripheral artery disease (PAD), including those with chronic limb-threatening ischemia (CLTI), has increased because of the increasing number of diabetic or dialysis patients worldwide. Revascularization is an important therapy for patients with CLTI. However, we sometimes experience refractory cases with insufficient peripheral circulation or microcirculation after revascularization. In this situation, additional therapy can be administered, such as low-density lipoprotein apheresis, high-pressure oxygen therapy, and spinal cord stimulation. However, they are not effective in some cases. Some reports have also indicated that transdermal isosorbide dinitrate patch (ISDN-P) is a useful therapy for PAD. As the efficacy of ISDN-P for patients with CLTI is not well-known, we examined it in this study. We assessed the skin perfusion pressure (SPP) after affixing an ISDN-P on the foot, because SPP measurement has proved useful in the assessment of PAD and is a good indicator of wound healing potential. The SPP (dorsal and plantar aspects) after ISDN-P application on the foot of healthy volunteers increased (n = 8; mean ± SD, 12.6 ± 7.9 [ P = .12], and 21.2 ± 7.7 mm Hg [ P < .05], respectively), as did SPP of patients with CLTI (n = 10; mean ± SD, 19.8 ± 2.5 [ P < .01], and 14.1 ± 5.9 mm Hg [ P < .05], respectively). All the patients who received an ISDN-P on the foot had no major complication, and no significant change in blood pressure. In conclusion, the ISDN-P is one of the effective and safe therapies for patients with CLTI.

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“…4 Overall, major amputation and progression of the ischemic process were not significantly decreased in CLI patients receiving HBO therapy only. 5 This may be because of diffusion of oxygen into a severely ischemic organ to create a hyperbaric environment is limited. Thus, HBO therapy may need certain conditions to result in a benefit for CLI patients, such as a certain degree of peripheral circulation.…”

Section: Introductionmentioning

confidence: 99%

Changes in Skin Perfusion Pressure After Hyperbaric Oxygen Therapy Following Revascularization in Patients With Critical Limb Ischemia: A Preliminary Study

Nakamura

Makiguchi

Atomura

et al. 2019

The International Journal of Lower Extremity Wounds

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Hyperbaric oxygen (HBO) therapy promotes wound healing in patients with ischemic disease; however, HBO-induced changes in skin peripheral circulation have not been evaluated in clinical practice. Here, we investigated these changes in patients with critical limb ischemia (CLI), with a focus on the angiosome of crural blood vessels with blood flow improved by endovascular therapy (EVT). Six patients with CLI and ulcers who were treated with HBO after EVT (7 limbs; 1 patient had ulcers in the bilateral limbs) and 3 healthy subjects (6 limbs) were enrolled. HBO therapy was performed at 2 atm under 100% oxygen for 90 min per session. Skin perfusion pressure (SPP) was measured in the dorsum and sole of the foot 1 hour before (pre-SPP) and after (post-SPP) HBO therapy. ΔSPP was calculated as post-SPP minus pre-SPP. SPP measurement regions were divided into those that did (direct region) and did not (indirect region) correspond to the vascular angiosome in which angiography findings of the crus were improved after EVT; i.e., when the anterior tibial artery was effectively treated with EVT, the dorsum was the direct region and the sole was the indirect region, and vice versa when the posterior tibial artery was treated. In the direct, indirect, and healthy subject groups, the ΔSPPs were 20.5±8.7 (p=0.002), –6.4±10.9, and –15.1±18.1 (p=0.014), respectively; that of the direct group was significantly greater than that of the other groups. These results suggest that short-term improvement of the peripheral circulation by HBO therapy was significant in patients with successful revascularization.

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Limitations of Hyperbaric Oxygenation in Occlusive Arterial Disease

Cited by 11 publications

References 8 publications

Circulatory Rejuvenated EPCs Derived from PAOD Patients Treated by CD34+ Cells and Hyperbaric Oxygen Therapy Salvaged the Nude Mouse Limb against Critical Ischemia

Circulatory Rejuvenated EPCs Derived from PAOD Patients Treated by CD34+ Cells and Hyperbaric Oxygen Therapy Salvaged the Nude Mouse Limb against Critical Ischemia

The Efficacy of the Transdermal Isosorbide Dinitrate Patch in Patients With Chronic Limb-Threatening Ischemia

Changes in Skin Perfusion Pressure After Hyperbaric Oxygen Therapy Following Revascularization in Patients With Critical Limb Ischemia: A Preliminary Study

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