Autologous bone marrow stem cell transplantation in patients with end-stage chronical critical limb ischemia and diabetic foot.
A total 37 patients suffering from end stage-IV Fontaine (CLI and diabetic foot) with an ulcerated limb in whom all previous therapeutic strategies failed (e.g. surgical revascularization and endovascular repair) were selected and underwent local transplantation of Autologous Bone Marrow Stem Cells (ABMSCs). The efficacy/safety ofthis therapy was assessed by using several endpoints such as (a) prevention of amputation, (b) wound healing and (c) degree of angiogenesis. In order to assess the limb ischemia and hypoxia the several tests and measurements were performed pre- and post transplantation at a variety of time intervals. The measurements include: TP-toe pressure measurements (by Periflux 5000 Laser Doppler and Oxymetry system), SPP-skin perfusion pressure, ABI-ankle brachial index, LDP-Laser Doppler baseline and heat perfusion assessment, TcpO2 without and with O2 provocation inhalation test. In addition, a battery of biochemical and hematological tests of peripheral venous blood samples and bone marrow analysis were performed. Limb salvage was 81% in 30 patients, 7 patients (19%) were amputated for terminal severe ischemia and gangrene progression. In the group of limb salvage patients initial Toe pressure 23.119 (std. error 5.358) increased in 90 days follow-up into 29.888 (std. error 5.99), Toe brachial index increased from 0.1469 (std. 0.0326) to 0.1991(std. 0.401). In LASER doppler and TcpO2, TcpCO2 tissue perfusion examination TcpO2% Increase after O2 provocation inhalation test was elevated from 162.95 (%) to 229.86% which confirmed a very good tissue vasoreactivity after BMSC transplantation.
Procházka
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Radiodiagnostic Institute University Hospital Ostrava-Poruba. angio@vol.cz
Gumulec
J
J
Chmelová
J
J
Klement
P
P
Klement
G L
GL
Jonszta
T
T
Czerný
D
D
Krajca
J
J
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001784:Blood Gas Analysis; D016026:Bone Marrow Transplantation; D017719:Diabetic Foot / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D017078:Laser-Doppler Flowmetry; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D014182:Transplantation, Autologous