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Shoji K, Yanishi K, Shiraishi H, Yamabata S, Yukawa A, Teramukai S, Imai K, Ito-Ihara T, Tao M, Higashi Y, Ishigami T, Fukumoto Y, Kuwahara K, Matoba S. Establishment of optimal exercise therapy using near-infrared spectroscopy monitoring of tissue muscle oxygenation after therapeutic angiogenesis for patients with critical limb ischemia: A multicenter, randomized, controlled trial. Contemp Clin Trials Commun 2020; 17:100542. [PMID: 32072074 PMCID: PMC7015992 DOI: 10.1016/j.conctc.2020.100542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/20/2020] [Accepted: 02/02/2020] [Indexed: 01/14/2023] Open
Abstract
Critical limb ischemia (CLI) is a potentially life-threatening condition that involves severely reduced blood flow to the peripheral arteries due to arteriosclerosis obliterans (ASO) of the limbs or a similar condition. CLI patients must undergo revascularization to avoid amputation of the lower limbs and improve their survival prognosis. However, the outcomes of conventional surgical revascularization or endovascular therapy are inadequate; therefore, establishing further effective treatment methods is an urgent task. We perform therapeutic angiogenesis using autologous bone marrow-derived mononuclear cells in clinical practice and demonstrated its safety and efficacy for CLI patients for whom conventional treatments failed or are not indicated. Exercise therapies must be devised for CLI patients who have undergone therapeutic angiogenesis to save their limbs and improve survival. Because evidence regarding the efficacy and safety of exercise therapy for CLI patients is lacking, we plan to perform a prospective trial of the efficacy and safety of optimal exercise therapy following therapeutic angiogenesis for CLI patients. The trial will enroll 30 patients between 20 and 79 years with Rutherford category 4 or 5 CLI caused by ASO who will undergo therapeutic angiogenesis. Participants will be randomly allocated to receive either optimal exercise therapy or fixed exercise therapy. Those receiving optimal exercise therapy will undergo tissue muscle oxygen saturation monitoring using near-infrared spectroscopy while performing exercises and will be prescribed optimal exercise therapy. The optimal amount of exercise will be determined on day 8, 31, 61, 91 and 181 after therapeutic angiogenesis. Ethics and dissemination This protocol was approved by the Institutional Review Boards of Kyoto Prefectural University of Medicine. In accordance with the Helsinki Declaration, written informed consent has been obtained from all participants prior to enrollment. The results of this trial will be disseminated by publication in a peer-reviewed journal. Trial registration This trial is registered at http://www.umin.ac.jp/ctr/index.htm (identifier: UMIN000035288).
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Key Words
- ASO, arteriosclerosis obliterans
- Arteriosclerosis obliterans
- BM-MNC, bone marrow-derived mononuclear cells
- CLI, critical limb ischemia
- CT, computed tomography
- Critical limb ischemia
- NIRS, near-infrared spectroscopy
- NO, nitric oxide
- Near-infrared spectroscopy
- Optimal exercise therapy
- PAD, peripheral artery disease
- RHI, reactive hyperemia index
- SPP, skin perfusion pressure
- StO2, thenar tissue oxygen saturation
- TAO, thromboangiitis obliterans
- TOI, tissue oxygenation index
- TcPO2, transcutaneous oxygen pressure
- Therapeutic angiogenesis
- Tissue muscle oxygen saturation
- VAS, visual analogue scale
- WIQ, walking impairment questionnaire
- eNOS, endothelial nitric oxide synthase
- nTHI, normalized tissue hemoglobin index
- ΔHHb, change in deoxygenated hemoglobin concentration
- ΔO2Hb, change in oxygenated hemoglobin concentration
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Affiliation(s)
- Keisuke Shoji
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Yanishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirokazu Shiraishi
- Rehabilitation Unit, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shiho Yamabata
- Rehabilitation Unit, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Arito Yukawa
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kojiro Imai
- Department for Medical Innovation and Translational Medical Science, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Toshiko Ito-Ihara
- The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masami Tao
- The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tomoaki Ishigami
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Yoshihiro Fukumoto
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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