title: Timing of gangrene tissue debridement after autologous bone marrow cell implantation in patients with superficial femoral arterial occlusion: preliminary experiences.
abstract: OBJECTIVE
  Although implantation of bone marrow mononuclear cells (BMI) was shown to improve outcomes in patients with severe peripheral arterial occlusive disease (PAOD), little experience has been reported in patients with an arterial occlusion level above the knee, ischemic gangrene, and high cardiovascular risk. This study sought to investigate the timing of gangrene tissue debridement and the safety of BMI in these patients.
  
  
  METHODS
  Six "no-option" PAOD patients were enrolled with an arterial occlusion level above the knee, ischemic gangrene, and 3 systemic diseases related to a high cardiovascular risk. The ischemic status was evaluated by measuring the ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), and wound healing after BMI.
  
  
  RESULTS
  All patients safely underwent the procedures with intravenous general anesthesia by titrating propofol. Major lower extremity amputation, minor debridement amputation, and debridement surgery were performed in 2 (33.3%), 1 (16.7%), and 2 (33.3%) patients, respectively, 3.1 2.8 months after BMI. Compared to the amputation group (N=3), the salvage group (N=3) had a significantly higher baseline ABI (P=0.02) and a shorter distance between the gangrene site and arterial occlusion site (P=0.01). In the 3 patients who underwent debridement, ABI and TcPO2 significantly improved 1 month after BMI, and gangrenous tissues were debrided 3.8 ± 3.6 (range, 1~8) months after BMI with complete healing within 1 month.
  
  
  CONCLUSIONS
  Autologous BMI therapy is safe in patients at high cardiovascular risk with an arterial occlusion level above the knee and ischemic gangrene. Effective predictors of BMI include the baseline ABI and distance to the ischemia. Gangrene tissue should be debrided at least 1 month after BMI.
authors.affiliation: Division of Cardiology, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan. bearty54@gmail.com
authors.forename: C H
authors.initials: CH
authors.lastname: Wang
authors.forename: Y J
authors.initials: YJ
authors.lastname: Lan
authors.forename: C H
authors.initials: CH
authors.lastname: Yeh
authors.forename: Y T
authors.initials: YT
authors.lastname: Ng
authors.forename: P V H
authors.initials: PV
authors.lastname: Chung
authors.forename: C M
authors.initials: CM
authors.lastname: Hsu
authors.forename: L T
authors.initials: LT
authors.lastname: Kuo
authors.forename: R E
authors.initials: RE
authors.lastname: Huang
authors.forename: M H
authors.initials: MH
authors.lastname: Liu
authors.forename: W J
authors.initials: WJ
authors.lastname: Cherng
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000704:Analysis of Variance; D015901:Angiography, Digital Subtraction; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001785:Blood Gas Monitoring, Transcutaneous; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology*; D003251:Constriction, Pathologic; D003646:Debridement / Q000009:adverse effects; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D005734:Gangrene; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011877:Radionuclide Imaging; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing