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.