Vaskulárna medicína 2/2010

Autologous stem cells in the salvage of ischaemic limb – preliminary reuslts

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. 20 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, photopletysmography, markers of endothelium and trombocytes´ activation and digital subtractive angiography. Results. The authors present the partial results of 20 patients concerning the number of saved limbs, the clinical picture, ABI, photopletysmography, pain severity, claudication interval. We have treated 20 patients, 3 of them had to undergo the limb amputation. So the therapy was successful in 85%. Conclusion. Marrow stem cell autotransplantation into the ischaemic lower limb seems to be a potentially effective method of peripheral perfusion enhancement and the limb salvage.

Keywords: critical limb ischemia, bone marrow stem cells, therapeutical angiogenesis