[The salvage of ischaemic limb by therapeutical angiogenesis].
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.


OBJECTIVE
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.
Talapková
R
R
Klinika transplantacnej a cievnej chirurgie Jesseniovej lekárskej fakulty UKa MFN Martin, Slovenská republika. rtalapkova@post.sk
Hudecek
J
J
Sinák
I
I
Kubisz
P
P
Laca
L
L
Hlinka
L
L
Zelenák
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016026:Bone Marrow Transplantation; D005260:Female; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D014182:Transplantation, Autologous