P-101 - STEM CELL THERAPY IN NON-REVASCULARIZABLE CRITICAL LIMB ISCHEMIA: RESULTS FROM A SINGLE CENTER

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Pietro M. (Gemelli Molise Hospital ~ Campobasso ~ Italy) , Enrico Maria C. (Gemelli Molise Hospital ~ Campobasso ~ Italy) , Maurizio M. (Gemelli Molise Hospital ~ Campobasso ~ Italy) , Veronica P. (Gemelli Molise Hospital ~ Campobasso ~ Italy) , Maria Pia P. (Gemelli Molise Hospital ~ Campobasso ~ Italy) , Antonio P. (ASREM Cardarelli Hospital ~ Campobasso ~ Italy) , Vincenzo F. (Gemelli Molise Hospital ~ Campobasso ~ Italy) , Savino C. (Gemelli Molise Hospital ~ Campobasso ~ Italy) , Andrea B. (Gemelli Molise Hospital ~ Campobasso ~ Italy)
Introduction:
This study aims to evaluate the efficacy of autologous stem cell transplantation in reducing the percentage of major amputations in patients with non-revascularizable Critical Ischemia (IC).
Methods:
From September 2008 to February 2021, 82 patients with non-revascularizable critical ischemia were enrolled in our Center. All patients were candidates for major amputation. 21 patients (29%) had extended dry gangrene and 22 patients (30%) had parcellar trophic lesions. All patients were subjected to transplantation of stem cells, taken from bone marrow and implanted in the ischemic limb. Patients underwent bone marrow harvesting from the posterior superior iliac crest under local anesthesia. In the same operating session, a total of 40 cc of bone marrow aspirate was injected into the muscles of the lower limb according to the pre-operative CT-angiography mapping. In particular, 40 distinct sites 1 cm apart from each other received 1 cc each of aspirate. Follow-up was performed at 3.6, 12 months
Results:
Peri-operative mortality (30 days) was 2 patients (2.4%). 12 deaths (14.6%) were recorded at the follow-up, mainly due to cardiovascular causes. There were 19 major amputations (23.2%) and 13 (18.8%) minor amputations or extensive necrosectomies. Overall, 77% of patient's candidate to amputation saved the limb. All patients presented a significant reduction in pain and a statistically significant tcpO2 increase (P = 0.008), especially in the first 2 months. The Rx- angiography at 6 months allowed to highlight the presence of a greater number of collateral circles than the pre-operative control, which seems to last even at 12 months.
Conclusion:
The proposed therapeutic option must be reserved to "non-revascularizable" ICs. This concept must be defined rigorously in order to allow this procedure to be a resource. Failures seems to be directly correlated with the presence of an advanced gangrene. In the follow up, patients treated at an early stage had greater benefits and better results over time. The use of autologous stem cells derived from bone marrow seems to be a valid therapeutic option, reducing the morbidity of patients suffering from non-revascularizable critical ischemia