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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2011 June;18(2):73-9
Autologous bone marrow stem cells transplantation in patients with critical limb ischemia not eligible for revascularization
Modugno P. 1, De Filippo C. M. 1, Caradonna E. 1, Amatuzio M. 1, Centritto E. M. 1, Sabusco A. 1, Di Giannuario G. 1, Piano S. 2, Giordano G. 2, Storti S. 2, Papini S. 3, Zappacosta B. 3, Sallustio G. 4, Rossi M. 5, Alessandrini F. 1
1 Department of Cardiovascular Disease, Centre of Research and Formation High Technologies “Johannes Paulus II” , Catholic University of Campobasso, Campobasso, Italy
2 Department of Onco-hematology , “Johannes Paulus II” Catholic University of Campobasso, Campobasso, Italy
3 Chemical Analysis Laboratory Unit, “Johannes Paulus II” Catholic University of Campobasso, Campobasso, Italy
4 Imaging Department, “Johannes Paulus II” Catholic University of Campobasso, Campobasso, Italy
5 Intensive Care Unit, “Johannes Paulus II” , Catholic University of Campobasso, Campobasso, Italy
Aim. Critical limb ischemia (CLI) represents a syndrome that is associated with a particularly adverse natural history. It is a rapidly progressive disorder associated with high morbidity and mortality. Only the 60% of patients can be treated and as many as 25% of patients die within the first year after presentation. The aim of this study was evaluate the use of autologus bone marrow concentrate (BMC, stem cells, platelets and citokine) implanted in patients not eligible for revascularization and candidate to limb amputation in a prospective observational study.
Methods. Ten consecutive patients affected by CLI resistant to conventional therapies and candidate to amputation were enrolled between 2008 and 2009. Ankle Brachial Index (ABI), transcutaneous oxygen saturation (TcpO2) and radiological imaging (angioMRI, angioTC, angiography) were performed at enrolment and during the follow up (1, 3 e 6 months). All patients were treated with auto transplant of BMC obtained with a point of case device (BMAC, Harvest technologies. Inc) and inoculated in the muscle around the critical ischemic zone in the same operative session.
Results. Operative mortality was 0%. 33% of patients underwent a limited amputation to a more distal point of the limb. All patients (100%) have presented a complete and persistent remission of rest pain with complete interruption of any analgesic drugs. ABI has shown a statistical relevant increment (P=0.008). Angiography studies at 6 months assess the presence of neo vascularization.
Conclusion. Auto transplant of BMC (stem cells, platelets and citokine) seems to be a safe and efficient option for the treatment of patients with CLI not eligible to conventional therapy.