Autologous stem cell transplantation in the treatment of critical limb ischemia after failure of conventional revascularization

doi:10.3877/cma.j.issn.2095-1221.2017.03.003

Abstract

Abstract:

Objective

To evaluate the efficacy of autologous stem cell transplantation in the treatment of critical limb ischemia after failure of conventional revascularization.

Methods

From May 2009 to November 2015, 14 patients with critical limb ischemia were enrolled and all of them had undergone conventional revascularization, including bypass surgery and stenting. The average age was 48±15 years (range, 21 ~ 75) . Conventional revascularization failed to improve ischemia in them. Apheresis was performed after 5-days' mobilization with GCSF to harvest stem cells. Stem cells were transplanted into the ischemic limb by intramuscular injection. Eleven patients were transplanted with purified CD34⁺ cells and 3 patients with peripheral blood mononuclear cells.

Results

Follow-up was accomplished in all 14 patients with an average follow-up time of (42±25) months (range 12 ~ 74) . During the follow-up there were 1 death and 2 major amputations which all occurred in aged patients with atherosclerosis obliterans. The overall survival rate 2 years after transplantation is 92.86﹪ (13/14) and the amputation free survival rate is 78.57﹪ (11/14) . The peak pain-free walking time at 6 months was significantly improved from (3±2) minutes to (12±8) minutes (P < 0.05, F = 14.95) and the Wong-Baker FACES pain rating score decreased from (7±1) to (1±1) (P < 0.05, F = 18.00) .

Conclusions

Autologous stem cell transplantation is safe and effective in treating critical limb ischemia after conventional revascularization failure.

Key words: Peripheral vascular diseases, Ischemia, Stem cell transplantation, Transplantation, autologous

Yuan Fang, Zhihui Dong, Zheng Wei, Weiguo Fu, Tianyue Pan, Shiyang Gu, Bin Chen, Daqiao Guo, Xin Xu, Peng Liu, Junhao Jiang, Jue Yang. Autologous stem cell transplantation in the treatment of critical limb ischemia after failure of conventional revascularization[J]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2017, 07(03): 136-140.

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Figures/Tables 4

References 19

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编号	PTA	PTA+Stent	取栓	溶栓	旁路手术	内膜剥脱	多次干预
1	1	?	?	?	?	?	?
2	1	?	?	?	?	?	?
3	?	?	2	?	1	?	1
4	?	?	1	?	?	?	?
5	?	1	?	?	?	?	?
6	2	1	1	?	1	?	1
7	?	?	?	1	?	?	?
8	?	1	?	1	?	?	1
9	1	1	?	2	?	?	1
10	?	?	?	?	1	?	?
11	?	?	?	1	?	?	?
12	?	?	?	1	1	1	1
13	?	1	?	?	?	?	?
14	?	?	?	1	?	?	?

编号	PTA	PTA+Stent	取栓	溶栓	旁路手术	内膜剥脱	多次干预
1	1	?	?	?	?	?	?
2	1	?	?	?	?	?	?
3	?	?	2	?	1	?	1
4	?	?	1	?	?	?	?
5	?	1	?	?	?	?	?
6	2	1	1	?	1	?	1
7	?	?	?	1	?	?	?
8	?	1	?	1	?	?	1
9	1	1	?	2	?	?	1
10	?	?	?	?	1	?	?
11	?	?	?	1	?	?	?
12	?	?	?	1	1	1	1
13	?	1	?	?	?	?	?
14	?	?	?	1	?	?	?

干预时间	干预方法	干预结果
2009年1月	股浅动脉PTA	改善后复发
2009年2月	股动脉-腘动脉人工血管旁路术	改善后复发
2009年12月	股浅动脉PTA+Stent	改善后复发
2010年6月	人工血管取栓术+PTA	改善后复发

干预时间	干预方法	干预结果
2009年1月	股浅动脉PTA	改善后复发
2009年2月	股动脉-腘动脉人工血管旁路术	改善后复发
2009年12月	股浅动脉PTA+Stent	改善后复发
2010年6月	人工血管取栓术+PTA	改善后复发

分组	Wong-Baker FACES疼痛（分）	无痛步行时间（min）
术前	7.14±0.66	3.38±2.61
术后6个月	1.08±0.90	11.97±7.92
术后1年	0.93±0.83	13.29±7.81
F值	18.00	14.95
P值	< 0.01	< 0.01

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