title: Autoperipheral blood mononuclear cell transplantation improved giant ulcers due to chronic arteriosclerosis obliterans.
abstract: We report the case of a 74-year-old man with Fontaine stage IV chronic arteriosclerosis obliterans who had been suffering from inveterate giant skin ulcers on the dorsum and heel of the right foot. As conventional medical treatments had not improved these ulcers and surgical treatment was considered unfeasible, amputation of the right lower limb below the knee appeared to represent the only option. The patient was admitted to Tottori University Hospital to attempt a new angiogenic therapy using auto-mononuclear cell transplantation to avoid amputation. On admission, neither right ankle blood pressure nor transcutaneous partial pressure of oxygen at the right toe were detectable. The patient had a history of multiple cerebral infarctions, and collection of mononuclear cells from bone marrow was considered too difficult, so collection of peripheral blood mononuclear cells was selected. Transcutaneous partial pressure of oxygen and skin temperature in the treated limb started to improve from 2 weeks after implantation. Ulcer size was recognizably reduced by 1 month after treatment. Partial auto-skin implantation on the right heel was performed 2 months after treatment, and the giant skin ulcer was finally completely covered. No adverse effects were noted during follow-up lasting 1 year. These results suggest that peripheral blood mononuclear cell implantation may offer a suitable alternative rescue therapy for patients with critical limb ischemia whose general condition is not good.
authors.affiliation: Department of Genetic Medicine and Regenerative Therapeutics, Institute of Regenerative Medicine and Biofunction, Tottori University Graduate School of Medical Science, 36-1 Nishimachi, Yonago, Tottori 683-8504, Japan.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Sugihara
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Matsubara
authors.forename: Katsunori
authors.initials: K
authors.lastname: Ishida
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsuura
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Ando
authors.forename: Go
authors.initials: G
authors.lastname: Igawa
authors.forename: Genta
authors.initials: G
authors.lastname: Narazaki
authors.forename: Junichiro
authors.initials: J
authors.lastname: Miake
authors.forename: Fumihito
authors.initials: F
authors.lastname: Tajima
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Nishio
authors.forename: Bin
authors.initials: B
authors.lastname: Nakayama
authors.forename: Osamu
authors.initials: O
authors.lastname: Igawa
authors.forename: Chiaki
authors.initials: C
authors.lastname: Shigemasa
authors.forename: Ichiro
authors.initials: I
authors.lastname: Hisatome
mesh_terms: D000368:Aged; D001162:Arteriosclerosis Obliterans / Q000150:complications* / Q000000981:diagnostic imaging; D002908:Chronic Disease; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007871:Leg Ulcer / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D007963:Leukocytes, Mononuclear / Q000637:transplantation*; D008297:Male; D018919:Neovascularization, Physiologic; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014463:Ultrasonography