title: Bone marrow aspirate injection for treatment of critical limb ischemia with comparison to patients undergoing high-risk bypass grafts.
abstract: OBJECTIVE
  Bone marrow cell therapy (BMCT) for patients with critical limb ischemia (CLI) is a potential treatment in candidates with poor options for standard revascularization procedures. Whereas clinical trials are ongoing, there are few comparative data to assess its efficacy compared with bypass.
  
  
  METHODS
  Patients with poor revascularization options underwent BMCT between 2011 and 2013. Outcomes were compared with those of a cohort of CLI patients undergoing infrainguinal bypass thought to be at high risk for graft failure (tissue loss, a tibial target, and a previous endovascular treatment or bypass). BMCT patients underwent harvest of bone marrow that was then concentrated and injected intramuscularly into the ischemic limb.
  
  
  RESULTS
  There were 20 BMCT patients and 35 high-risk bypass patients. All BMCT patients had either rest pain (80%) or tissue loss (80%). The majority (65%) had a prior intervention (bypass, 30%; endovascular, 58%) compared with high-risk bypass patients, all of whom had previous revascularization attempts (bypass, 43% [P = .35]; endovascular, 77% [P = .14]). Mean follow-up was 773 days after BMCT and 972 days after high-risk bypass. All patients tolerated BMCT without issues or complications. A second BMCT treatment was performed in 21% because of clinical deterioration. Wound healing occurred in 75% at 1.5 years, including patients receiving second injections, all of which resolved. Rest pain improved in 87.5% of patients. Pain completely resolved in 58% at 1.5 years. Ankle-brachial index improvement was 0.23 (±0.25). Three BMCT patients went on to amputation. One-year freedom from major amputation or death was 78% for BMCT vs 69% for high-risk bypass (P = .60).
  
  
  CONCLUSIONS
  BMCT is a potential option in CLI patients who are not candidates for bypass or endovascular intervention. Limb salvage is unexpectedly high in this population with few other options.
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Kristina A
authors.initials: KA
authors.lastname: Giles
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Rzucidlo
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Walsh
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: richard.j.powell@hitchcock.org.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Powell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D055109:Ankle Brachial Index; D064592:Autografts; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality; D016638:Critical Illness; D018572:Disease-Free Survival; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007273:Injections, Intramuscular; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
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