Herold J, Said S, Braun-Dullaeus R
Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland.
Zentralbl Chir. 2014 Oct;139(5):508-17. doi: 10.1055/s-0033-1350668. Epub 2013 Oct 2.
Collateral vessel growth is a physiological process that is not equally pronounced in all people. After the development of a haemodynamically relevant stenosis in vascular systems, blood flow is directed through a collateral circulation to supply ischaemic tissue. This collateral circulation exists on the capillary level and by definition, is not composed of real new vessels. Postnatal vasculogenesis (true neovascularisation) occurs in the adult organism in tumour vascularisation, wound healing, in the endometrium, and in the context of chronic diseases such as rheumatoid arthritis and psoriasis. Reopening of the occluded vessel or use of artificial bypass grafts are the most attractive therapeutic approaches for treating peripheral arterial and coronary artery disease. These strategies have been exhausted in many patients; therefore augmentation of arteriogenesis can be more useful. Arteriogenesis, the promotion of natural collateral growth, is a hot topic in vascular research. Monocytes play a key role in arteriogenesis by "homing" to areas of collateral vessel growth and locally secrete multiple essential growth factors. Furthermore, stem cells of different origins, endothelial progenitor cells or mononuclear cells are currently being used to promote vessel growth. Also, the application of growth factors such as VEGF, MCP-1, GM-CSF have been already used in clinical trials. This review article describes the physiology and pathophysiology of vascular stenoses and their compensation mechanisms. The review also gives an overview of current treatment approaches and new strategies for non-operable PAD patients. The article presents the current cell and growth factor-related studies, as well as results of balloon dilatation and stent implantation or bypass surgery studies for improvement of revascularisation.
侧支血管生长是一种生理过程，在所有人中表现并不相同。在血管系统中出现具有血流动力学意义的狭窄后，血流会通过侧支循环来供应缺血组织。这种侧支循环存在于毛细血管水平，根据定义，它并非由真正的新血管组成。出生后血管生成（真正的新生血管形成）在成年生物体中发生于肿瘤血管生成、伤口愈合、子宫内膜以及类风湿关节炎和银屑病等慢性疾病的情况下。重新开通闭塞血管或使用人工旁路移植物是治疗外周动脉疾病和冠状动脉疾病最具吸引力的治疗方法。这些策略在许多患者中已被用尽；因此增强动脉生成可能更有用。动脉生成，即促进自然侧支生长，是血管研究中的一个热门话题。单核细胞通过“归巢”到侧支血管生长区域并在局部分泌多种重要生长因子，在动脉生成中起关键作用。此外，目前正在使用不同来源的干细胞、内皮祖细胞或单核细胞来促进血管生长。而且，生长因子如血管内皮生长因子（VEGF）、单核细胞趋化蛋白 -1（MCP -1）、粒细胞 - 巨噬细胞集落刺激因子（GM - CSF）的应用已在临床试验中开展。这篇综述文章描述了血管狭窄的生理和病理生理学及其代偿机制。该综述还概述了当前针对无法进行手术的外周动脉疾病（PAD）患者的治疗方法和新策略。文章介绍了当前与细胞和生长因子相关的研究，以及球囊扩张、支架植入或旁路手术研究用于改善血管再通的结果。
