Validity of Adjuvant Therapy in Patients with Lower Limb Critical Ischemia
- #VS 01-O-6
- Vascular Surgery. SESSION-1
- Oral
Validity of Adjuvant Therapy in Patients with Lower Limb Critical Ischemia
Giovanni Giannace, Massimiliano Walter Guerrieri, Carlo Setacci, Domenico Benevento
VASCULAR SURGERY UNIVERSITY OF SIENA, SIENA, Italy
Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–B
Abstract
INTRODUCTION Cell angiogenic therapy performed by the implantation of autologous mononuclear
cells A-PBMNC (autologous peripheral blood mononucleate cells) has demonstrated
safety and efficacy in the treatment of critical limb ischemia in patients who
are not candidates for revascularization. The aim of our study is to evaluate
the possible adjuvant effect of angiogenic therapy not only in critical
non-revascularizable ischemia, but also after endovascular revascularization.
METHODS 10 patients with critical ischemia of the lower
limbs were subjected to infiltration of mononuclear cells
taken from peripheral blood (A-PBMNC). 7 were not
candidates for endovascular or surgical revascularization procedures. 3 patients
underwent treatment with A-PBMNC together with an endovascular
revascularization procedure and 1 of these 3 patients performed a control
angiography. We have used the
Monocell selective filtration system that allows to produce the
concentrate directly in the operating room at the time of the procedure,
without any manipulation, in conditions of absolute sterility. Our follow-up includes weekly clinical checks and instrumental with
doppler.
RESULTS There were no major adverse events or
limb amputations. In all the treated patients there
was a reduction in pain on the VAS scale compared to the baseline mean value , a reduction in the average area of ulcers, an increase
in TCPO2 after the third cycle and an increase in the ABI values. One
of the 3 patients who underwent infiltration of mononuclear cells and revascularization by an endovascular
procedure, was subjected to angiography
that tested to the presence of neovessels compared to angiography performed at
the end of the procedure.
CONCLUSIONSTherapeutic angiogenesis appears to be a safe and potentially effective
strategy for the treatment of critical limb ischemia also as adjuvant
therapy in patients revascularizable or revascularized in which the poverty of
the peripheral vascular bed prevents the achievement of a
satisfactory result.