• minor amputation [ Time Frame: six months ] [ Designated as safety issue: Yes ]
• number and extent of leg ulcers [ Time Frame: six months ] [ Designated as safety issue: No ]
• resolvement of rest pain [ Time Frame: six months ] [ Designated as safety issue: No ]
• improvement of ankle-brachial index (ABI) [ Time Frame: six months ] [ Designated as safety issue: No ]
• improvement transcutaneous oxygen pressure (TcpO2) [ Time Frame: six months ] [ Designated as safety issue: No ]
• changes in quality of life [ Time Frame: suix months ] [ Designated as safety issue: No ]
• changes in clinical status (Rutherford classification) [ Time Frame: six months ] [ Designated as safety issue: No ]

• CLI related hospitalisation
• walking test
• ankle-brachial pressure index
• transcutaneous oxygen pressure
• vasculogenesis assessed with MRA
• pain score
• quality of life

The purposes of this study are to determine whether intra-arterial injection of autologous stem cells is effective in the treatment of chronic limb ischemia (CLI), to characterize stem cell dysfunction in patients with CLI, and to relate the stem cell function with clinical outcome.

Despite advances in surgical and radiological vascular techniques, a significant number of patients with chronic critical limb ischaemia (CLI) are not eligible for revascularization procedures, often leaving amputation as the only option. Consequently, exploring new strategies for revascularization of ischemic limbs is of major importance. Preclinical studies and pioneering clinical trials suggest that administration of bone marrow (BM) mononuclear cells (MNC) into ischemic limbs enhances neovascularization, improves tissue perfusion and prevents amputation. However, no definite proof is available as the clinical studies thus far have been small and lacked double-blinded controls.

JUVENTAS is a randomized, double-blinded placebo-controlled trial in 109 - 160 patients with CLI to investigate the potential clinical effects of repeated intra-arterial infusion of BM-MNC in these patients (the exact number of patients to be included cannot be specified in advance because of the planned group sequential interim analyses). In addition, it will study the functional characteristics of the BM-MNC obtained from CLI patients and relate BM-MNC dysfunction to clinical outcome.

• Peripheral Vascular Diseases
• Arterial Occlusive Diseases
• Leg Ulcer
• Gangrene
• Ischemia

• Procedure: Bone marrow punction
• Procedure: BM-MNC infusion
• Procedure: Placebo infusion

• Experimental: autologous bone marrow-derived mononuclear cells
• Placebo Comparator: Placebo

Inclusion Criteria:

• Age > 18 years
• Severe infra-popliteal peripheral arterial occlusive disease [PAOD] (Fontaine class IIb, III or IV)
• Invalidating intermittent claudication, persistent, recurring rest pain requiring analgesia and/or non-healing ulcers present for > 4 weeks without evidence of improvement in response to conventional therapies
• Ankle brachial index < 0.6 or "non-compressible"
• Not eligible for surgical or radiological revascularization
• Written informed consent

Exclusion Criteria:

• History of neoplasm or malignancy in the past 10 years
• Serious known concomitant disease with life expectancy of less than one year
• Anticipated inability to obtain 100 ml of bone marrow aspirate
• Known infection with human immunodeficiency virus (HIV), hepatitis B or hepatitis C virus
• Follow-up impossible