[Prognostic factors for critical limb ischemia after autologous bone marrow implantation].
OBJECTIVE
Autologous bone marrow implantation (BMI) is effective to treat critical limb ischemia, but the long-term prognosis is not clear. The outcome of BMI treatment for ischemic legs was investigated related to the clinical background of the patient, and short-term effects of BMI. The end event was defined as unexpected lower limb amputation.


RESULTS
This study included 21 consecutive patients (mean age 60.0 +/- 13.6 years) with peripheral arterial disease who underwent BMI between December 2001 and March 2005. Twelve patients had arteriosclerosis obliterans (ASO), 5 had Buerger disease (thromboangiitis obliterans), 3 had thromboembolism, and 1 had hypereosinophilic syndrome. The patients with ASO had severe complications such as diabetes and hyperlipidemia. The total number of transplanted CD34-positive cells, ankle-brachial pressure index (ABI), and tissue oxygen pressure (TcO2) were lower in ASO patients than non-ASO patients. Significant risk factors for the event were diagnosis of ASO and low TcO2 (< 30 mmHg) according to the Kaplan-Meier survival curve and log rank test. All 6 patients who required limb amputation had ASO simultaneously with low TcO2 (6 of 9, 67%). In contrast, there was no correlation between the end event and short-term effect of BMI such as improvements in ABI and TcO2.


CONCLUSIONS
Treatment with BMI could not save legs in some patients with ASO associated with severe leg ischemia.
Oda
Masato
M
Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata. odamasato@pop01.odn.ne.jp
Kato
Kiminori
K
Toba
Ken
K
Otaki
Keita
K
Kitajima
Toshiki
T
Ikarashi
Noboru
N
Yanagawa
Takao
T
Higashimura
Masutaka
M
Asami
Fuyuki
F
Isoda
Manabu
M
Ozawa
Takuya
T
Moriyama
Masato
M
Hirono
Satoru
S
Okura
Yuji
Y
Hanawa
Haruo
H
Kodama
Makoto
M
Aizawa
Yoshifusa
Y
D000368:Aged; D000842:Ankle / Q000098:blood supply; D018952:Antigens, CD34; D001162:Arteriosclerosis Obliterans / Q000150:complications; D001785:Blood Gas Monitoring, Transcutaneous; D001794:Blood Pressure; D016026:Bone Marrow Transplantation; D001916:Brachial Artery / Q000502:physiology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010313:Partial Pressure; D011379:Prognosis; D014182:Transplantation, Autologous
D018952:Antigens, CD34