Enhancing limb salvage by non-mobilized peripheral blood angiogenic cell precursors therapy in patients with critical limb ischemia.
BACKGROUND
Stem cell therapy has been proposed to enhance the salvage of critically ischemic limbs.


OBJECTIVE
Assess the efficacy and safety of the implantation of non-mobilized peripheral blood angiogenic cell precursors (NMPB-ACPs) in patients with critical limb ischemia (CLI) who were poor candidates for standard revascularization treatment options.


METHODS
Six patients with CLI due to the infrapopliteal artery occlusive disease were included in the present study. Intramuscular injections of NMPB-ACPs were administered in the ischemic limbs. The efficacy was evaluated by clinical outcomes, ankle brachial index, toe brachial index, and computerized tomographic angiography.


RESULTS
There was no evidence of local or systemic complication related to the procedure. Five patients (83.3%) had clinically significant improvement of adequate circulation at the distal limb for the complete healing. Four of them had complete healing of ischemic ulcers and stumps of toe amputation. However one patient with adequate granulation tissue at the stump of the left first toe amputation subsequently suffered from severe foot infection originating from the other toes and eventually underwent below knee amputation. There was no improvement of circulation at the distal limb after the administration of NMPB-ACPs in one patient (16.7%) who eventually underwent major amputation.


CONCLUSIONS
The preliminary result of NMPB-ACPs therapy may be safe and provide benefits in the improvement of circulation in patients with CLI. A larger controlled trial is required to ascertain these preliminary results.
Mutirangura
Pramook
P
Vascular Surgery Unit, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok Thailand. pramook_siriraj@hotmail.com
Ruangsetakit
Chanean
C
Wongwanit
Chumpol
C
Chinsakchai
Khamin
K
Porat
Yael
Y
Belleli
Adina
A
Czeiger
David
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000672:Amputation Stumps / Q000098:blood supply / Q000601:surgery; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000628:therapy; D016638:Critical Illness; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000209:etiology / Q000628:therapy*; D005734:Gangrene; D006801:Humans; D007273:Injections, Intramuscular; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D007866:Leg / Q000098:blood supply; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D014034:Toes / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome