The Salvage of Ischaemic Limb by Therapeutical Angiogenesis

Czech version

Authors: R. Talapková ¹; J. Hudeček ²; I. Šinák ¹; P. Kubisz ²; Ľ. Laca ¹; Ľ. Hlinka ¹; K. Zeleňák ³
Authors‘ workplace: Klinika transplantačnej a cievnej chirurgie Jesseniovej lekárskej fakulty UK a MFN Martin, Slovenská republika, prednosta doc. MUDr. Ľudovít Laca, Ph. D., mim. prof. ¹; Klinika hematológie a transfuziológie Jesseniovej lekárskej fakulty UK a MFN Martin, Slovenská republika, prednosta prof. MUDr. Peter Kubisz, DrSc. ²; Klinika rádiologie Jesseniovej lekárskej fakulty UK a MFN Martin, Slovenská republika, prednosta MUDr. Hubert Poláček, Ph. D. ³
Published in: Vnitř Lék 2009; 55(3): 179-183
Category: 15th Parizek's Days

Overview

Background:
Critical limb ischaemia (CLI) is defined as a chronic rest pain, lasting more than 2 weeks, requiring analgesics and/or with present skin defects. Autologous transplantation of bone marrow mononuclear cells has been used successfully in CLI.

Aim:
The salvage of critically ischaemic limb by endotel progenitory cells (EPCs) from patient’s bone marrow. To assess efficacy and safety of critical lower limb ischaemia treatment with marrow stem cell autotransplantation.

Methods:
9 patients suffering from CLI have been enrolled. They did not require emergency amputation and had previously been unsuccessfully treated with conventional therapy. Mononuclear cells were isolated from the bone marrow taken from illiac crest and injected in the gastrocnemius muscle and pedal region of the affected limb. Patients have had evaluated: local finding, pain index, quality of life index, ABI, fotopletysmography, markers of endothelium and trombocytes’ activation and digital subtractive angiography.

Results:
Pain severity decreased in all of patients. Three of them are with no pain and no claudication. Lesions resolved in two patients, partially in three patients. Crural amputation was required in two patients, amputation of leg in 1 patient. No side effects of the therapy were observed. One patient died without connection with procedure.

Conclusions:
Marrow stem cell autotransplantation into the ischaemic lower limb seems to be a potentially effective method of peripheral perfusion enhancement. Further studies are needed to clarify the underlying mechanisms of such improvement.

Key words:
critical limb ischemia –⁠ bone marrow stem cells –⁠ therapeutical angiogenesis

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