What is Angiogenesis?

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Angiogenesis describes the physiological process when new blood vessels form from existing ones.

Angiogenesis and vasculogenesis both play critical roles in new blood vessel formation. Angiogenesis describes the physiological process when new blood vessels form from existing ones.

When does angiogenesis occur?

Angiogenesis occurs only after vasculogenesis, the differentiation of endothelial precursor cells, known as angioblasts, into endothelial cells and the de novo formation of a vascular network.

Angiogenesis refers to the growth of new capillaries, and the process begins occurring in utero and continues throughout the human lifespan – during health, illness, and old age, including:

  • embryonic development growth
  • implantation of placenta
  • uterine lining
  • wound healing
  • non-malignant disease: diabetic retinopathy, psoriasis, RA
  • malignant disease: tumorigenesis

What is the effect of shockwave therapy on angiogenesis?

Low-intensity Extracorporeal Shockwave Therapy (Li-ESWT) creates shear stress, which in turn causes intracellular and extracellular responses. Then, there is stimulation of endothelial Nitric Oxide Synthase (eNOS) and the release of Vascular Endothelial Growth Factors (VEGF). After VEGF is released, it binds to receptors on the ends of endothelium of blood vessels.

Subsequent to Li-ESWT, increased expression of VEGF in the treated tissue is a consistent finding in studies, together with increased expression of endothelial markers such as platelet and endothelial cell adhesion molecules. 

In other words, Li-ESWT effectively stimulates growth factors, such as VEGF. It also contributes to the proliferation of new blood vessels.

Angiogenesis History 

  • 1787 – Angiogenesis was first used by British surgeon Dr. John Hunter to describe blood vessels in reindeer antler
  • 1950s – Shockwave therapies were first introduced to encourage angiogenesis and stimulate the body’s natural healing processes (without surgery)
  • 1971 – Dr. Judah Folkman, considered the father of angiogenesis, first observed pathological implications of angiogenesis in cancer, Massachusetts General Hospital

Why is oxygen significant in angiogenesis?

Angiogenesis is important during development and healing because new tissues need oxygen and nutrients which are supplied by blood vessels. 

In fact, ischemia means the patient cannot get enough oxygen to certain organs. Poor cardiovascular health can be detrimental to a person, whereas a healthy cardiovascular system helps heal and improves pain. A healthy cardiovascular system in a healthy body can grow new blood vessels in damaged tissue more easily and heal better, faster. 

Shockwave therapies induce healthy angiogenesis; new blood vessels are formed naturally without drugs or injections.

Angiogenesis and diabetes

Many complications of diabetes are associated with poor circulation, lack of perfusion, and/or poor vascularization. Therefore, angiogenesis by shockwave therapy is considered a potential therapeutic strategy. In fact, therapeutic angiogenesis remains an attractive treatment modality for chronic ischemic disorders, including Peripheral Artery Disease (PAD) and/or diabetic wound healing.

A normal healthy body maintains a balance of angiogenesis modulators, or a series of on and off switches:

  • On switches – angiogenesis stimulating growth factors
  • Off switches – angiogenesis inhibiting growth factors

Whereas, a diabetic or patient with chronic ischemic disorder has an imbalance and may require additional stimulation for blood vessel growth.


Before After / Following Medispec shockwave therapy


In this photo, you see before and after shockwave therapy. Tissue regeneration and new blood vessel formation were directly responsible for diabetic wound healing. 

Interested in how shockwaves can aid in diabetic healing?

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