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, Clinic of Thoracic and Cardiovascular Surgery St. George’s, Moscow
Abstract
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.
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