[Clinical efficacy of autologous bone marrow mononuclear cell transplantation in treating lower limb thromboangiitis obliterans].
OBJECTIVE
To investigate the efficacy of autologous bone marrow mononuclear cells transplantation in treating lower limb thromboangiitis obliterans (TAO).


METHODS
From January 2005 to November 2008, 25 patients (27 limbs) with lower limb TAO were treated. There were 24 males (26 limbs) and 1 female (1 limb), aging 16-44 years (33 years on average). Fifteen left limbs and 12 right limbs were involved. The median duration of disease was 2 years (from 3 months to 9 years). Intermittent claudication was observed in 5 cases (5 limbs), 16 patients (17 limbs) had symptom of rest pain, 4 patients (5 limbs) suffered ulcer on the distal limbs. The results of visual analogue scale (VAS), maximum walking distance (MWD), ankle/brachial index (ABI), and transcutaneous oxygen pressure (TcPO2) before operation were (7.16 +/- 1.12) points, (0.098 +/-0.043) km, 0.20 +/- 0.09, and (11.78 +/- 3.46) mm Hg (1 mm Hg=0.133 kPa), respectively. A total of 300 mL bone-marrow blood was extracted from the iliac bone. And then the mononuclear cells were isolated from the bone-marrow blood. All patients received cell transplantation only one time. The amount of transplantation bone marrow mononuclear cells was (1.82-29.46) x 10(9) (mean 13.33 x 10(9)).


RESULTS
All patients were followed up for 1 years. After 4 weeks of implantation, the results of VAS, MWD, ABI, and TcPO2 were (2.39 +/- 0.51) points, (0.783 +/- 0.176) km, 0.28 +/- 0.16, (21.33 +/- 6.57) mm Hg, respectively, showing significant difference compared with preoperative results (P < 0.05). The VAS, MWD, ABI, and TcPO2 increased to (2.44 +/- 0.67) points, (1.199 +/- 0.304) km, 0.37 +/- 0.09, (27.90 +/- 5.23) mm Hg after 1 year of implantation, showing significant differences compared with preoperative results (P < 0.05). One ulcer healed well and the improvement was obtained in other 3 cases after 4 weeks of implantation (80%). Four ulcers healed well after 1 year of implantation (80%). After 1 year of implantation, angiography revealed 37.04% affected limbs had a satisfactory neovascularization. The angiographic levels were grade 0 in 5 cases, grade 1 in 12 cases, grade 2 in 4 cases, and grade 3 in 6 cases.


CONCLUSIONS
Autologous bone marrow mononuclear cells transplantation could be a simple, safe, effective method to treat TAO.
Wang
Wei
W
Department of Vascular Surgery, the Affiliated Drum Tower Hospital, Medical College of Nanjing University, Nanjing Jiangsu, 210008, P.R. China. weiwangdoc@163.com
Liu
Changjian
C
Qiao
Tong
T
Liu
Chen
C
Huang
Dian
D
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D009000:Monocytes; D013919:Thromboangiitis Obliterans / Q000601:surgery*; D014182:Transplantation, Autologous; D055815:Young Adult