DOI: 10.25881/BPNMSC.2020.22.20.004

Authors

Sukovatyh B.S.1, Orlova A.Yu.1, Sukovatyh M.B.1, Bolomatov N.V.2

1 Kursk State Medical University, Kursk

2 Pirogov National Medical and Surgical Center, Moscow

Abstract

The goal is to study the hemodynamic and clinical effectiveness of bone marrow cell autotransplantation in critical limb ischemia in comparison with revascularizing osteotrepanation and lumbar sympathectomy.

Material and methods. The analysis of a comprehensive examination and treatment of 99 patients with critical lower limb ischemia, divided into 3 statistically homogeneous groups, was carried out. In the first group, classical revascularizing osteotrepanation was performed, in the second — lumbar sympathectomy, and in the third — implantation of autologous bone marrow cells. Hemodynamic efficacy was evaluated by increasing rheovasographic, ankle-brachial and photoplethysmographic indices, painless walking distance, clinical — by improving the status of patients on the scale of Ruterford et al.

Results. After 1 year, the volumetric blood flow in the ischemic limb after implantation of autologous bone marrow cells was 2.1 times higher than after revascularizing osteotrepanation and 2.0 times higher than after lumbar sympathemia, main blood flow was 1.6 and 1.4 times, respectively microcirculation at 8.8% and 13.3%, painless walking distance at 19 and 27 meters. The one-year clinical efficacy of the classic revascularizing osteotrepanation was 60.6%, lumbar sympathectomy — 42.4% and autologous bone marrow cell implantation — 94%. The limb was preserved in 26 (78.8%) in the first group, in 30 (90.7%) patients in the second group, and in 32 (97%) in the third group.

Conclusion: the implantation of autologous bone marrow cells in stage III critical ischemia of the lower extremities in patients with a lack of a perceptive bed is effective.

Keywords: critical ischemia, lower limbs; lumbar sympathectomy, autologous bone marrow cell implantation, revascularizing osteotrepanation.

References

1. Bulgin DV, Andreeva OV. Therapeutic angiogenesis by growth factors and bone marrow mononuclear cells administration biological foundation and clinical prospects. Vestnik transplantologii i iskusstvennykh organov. 2015;17(3):89–111. (In Russ). Doi: 10.15825/1995-1191-2015-3-89-111.

2. Kosayev DjV, Budagov IK, Namazov IL. Clinical and pathogenetic aspects of the revascularizing osteotrepanation in patients with critical lower limb ischemia. Vestnik Avicenny. 2013;(4):19-24. (In Russ).

3. Kohan EP, Pinchuk OV. Deliberations on lumbar sympathectomy: years and practice on the occasion of the 90th anniversary of using the method in Russia. Angiology and vascular surgery. 2017;23(2):186-190. (In Russ).

4. Natsional'nye rekomendatsii po vedeniyu patsientov s zabolevaniyami arterii nizhnikh konechnostei. Moscow: Meditsina; 2013. 67 p. (In Russ).

5. Sukovatykh BS, Orlova AYu. Stimulation of angiogenesis by bone marrow cells in experimental ischaemia of lower limb. Angiology and vascular surgery. 2017;23(1):43-50. (In Russ).

6. Chervyakov YuV, Staroverov IN, Borisov AV, et al. Remote 3-year results of application of "indirect" ways of revascularization in patients with chronic ischemia of lower extremities. Vestn Khir Im I I Grek. 2015;(2):84–88. (In Russ).

7. Shevchenko YuL, Borshchev GG. Stimulation of angiogenesis with endogenic growth factors. Bulletin of Pirogov National Medical & Surgical Center. 2018;13(3):96-102. (In Russ). Doi: 10.25881/BPNMSC.2018.73.55.022.

8. Nakamura H, Makiguchi T, Atomura D, et al. Changes in skin perfusion pressure after hyperbaric oxygen therapy followingrevascularization in patients with critical limb ischemia: a preliminary study. Int J Low Extrem Wounds. 2019;19(1):57-62. Doi: 10.1177/1534734619868925.

9. Osipova O, Saaya S, Karpenko A, et al. Cell therapy of critical limb ischemia-problems and prospects. Vasa. 2019;48(6):461-471. Doi: 10.1024/0301-1526/a000787.

10. Sen I, Agarwal S, Tharyan P, Forster R. Lumbar sympathectomy versus prostanoids for critical limb ischaemia due to non-reconstructable peripheral arterial disease. Cochrane Database Syst Rev. 2018;4:CD009366. Doi: 10.1002/14651858.CD009366.pub2.

11. Yusoff FM, Kajikawa M, Matsui S, et al. Review of the long-term effects of autologous bone-marrow mononuclear cell implantation on clinical outcomes in patients with critical limb ischemia. Sci Rep. 2019;9(1):7711. Doi: 10.1038/s41598-019-44176-5.

12. Zechlinski JJ, Hieb RA. Lumbar sympathetic neurolysis: how to and when to use? Tech Vasc Interv Radiol. 2016;19(2);163–168. Doi: 10.1053/j.tvir.2016.04.008.

For citation

Sukovatyh B.S., Orlova A.Yu., Sukovatyh M.B., Bolomatov N.V. Hemodynamic and clinical effectiveness of the bone marrow cell transplantation in treatment of critical ischemia of the lower extremities. Bulletin of Pirogov National Medical & Surgical Center. 2020;15(1):27-31. (In Russ.) https://doi.org/10.25881/BPNMSC.2020.22.20.004