Indirect revascularization in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus

Keywords: critical ischemia of the lower extremities; indirect revascularization; mesenchymal stem cells; cellular transplantation.

Abstract

Objective. Determination of clinical efficacy of the mesenchymal stem cells transplantation in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus.

Materials and methods. There were examined 11 patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus Type II with purulent-necrotic processes of the foot, in whom conditions for the direct revascularization of extremity were absent. Microbiological monitoring for the wound discharge, determination of the ankle brachial index and transcutaneous oximetry was performed. The technology elaborated have consisted of two stages. On the first of them a purulent focus sanation (in all the patients the distal amputations of the foot, preserving arterial arch) was done. On the second stage the therapy of the wounds was conducted, using negative pressure, injections of cellular suspension (mesenchymal stem cells) while applying long fine cannula under aponeurosis into the muscles along obliterated vessels in the (10 ± 5) ml quantity with subsequent closure of the wound surface, using fibroblastic matrix.

Results. In a year after the treatment critical ischemia in 1 patient was noted, the ischemia Grade III - in 3, and in 7 a IIB Grade have persisted.

Conclusion. Performance of indirect revascularization, using autologous mesenchymal stem cells, constitutes an effective and secure procedure.

Author Biographies

Yu. V. Ivanova, Kharkov National Medical University

Ivanova Julia – MD, DSci(Med), Professor,
Department of Surgery No. 1,
Kharkiv National Medical University,
1 Balakirev entry, 61018, Kharkov, Ukraine;
057-349-41-94;
dr.ivanova23@gmail.com;
https://orcid.org/0000-0001-8773-6827

I. A. Kryvoruchko, Kharkov National Medical University

Kryvoruchko Igor Andriiovych – MD, DSci(Med), Professor,
Head Department of Surgery No. 2,
Kharkiv National Medical University,
ikryvoruchko60@gmail.com
https://orcid.org/0000-0002-5525-701X

V. A. Prasol, Kharkov National Medical University

Prasol Vitaliy – MD, DSci(Med), Professor,
Department of Surgery No. 1,
Kharkiv National Medical University,
1 Balakirev entry, 61018, Kharkov, Ukraine
dr.prasol@gmail.com
https://orcid.org/0000-0002-0556-6981

K. V. Miasoiedov, Kharkov National Medical University

Miasoiedov Kyrylo – MD, PhD(Med), Assistent
Department of Surgery No. 1,
Kharkiv National Medical University,
1 Balakirev entry, 61018, Kharkov, Ukraine;
vonmiasoiedov@gmail.com
https://orcid.org/0000-0002-3878-7713

S. A. Andreieshchev, Shupyk National Healthcare University of Ukraine, Kyiv

Andreieshchev Sergey A., MD, PhD, associate professor,
associate professor Department of Surgery and Transplantology,
Shupyk National University of Health of Ukraine, Kyiv, Ukraine.
30 Heroiv Sevastopolia Str., 03680, Kyiv, Ukraina,
+38 (044) 4081811
info@hirurgiya.com.ua
http://orcid.org/0000-0002-2281-1803

References

Gavrilenko AV, Skrilev SI. Arterialization of the venous blood flow of the leg and foot is an alternative method for saving the limb. In: Materials of the 16th International Conference "New in Angiology and Vascular Surgery". Moscow, November 21-3, 2005. Angiology and vascular surgery. 2005; 2 (supll):86. In Russian.

Gavrilenko AV, Skrylev SI, Kuzubova EA. Quality of life assessment in patients with critical lower limb ischemia. Angiology and Vascular Surgery. 2001;7(3):8-14. Russian.

Varaksin VA. Surgical treatment of patients with obliterating lesions of the arteries of the distal parts of the lower extremities. PhD(Med) [thesis]. Yaroslavl;1994. 20 p. Russian.

Egorov AA. Clinical and pathogenetic aspects of revascularizing osteotherapy operation in patients with obliterating atherosclerosis of the arteries of the lower limbs. PhD(Med) [thesis]. Ryazan: RGMU;2007.21 p. Russian.

Zusmanovich FN, Dmitriev VM. Indications and contraindications for revascularizing osteotrepanation (ROT) in the treatment of chronic arterial insufficiency of the extremities. Angiology and Vascular Surgery. 1995;1(2):11. [In Russian].

Bel'kov IuA, Kyshtymov SA, Bogdanova MG, Dudnik AV. Revascularizing osteotrepanation in combined surgical treatment of chronic lower limb ischemia. Khirurgiia (Mosk). 2004;(9):14-6. Russian. PMID: 15477805.

Kislov EE, Panfilov CD, Zoloev GK, Dedikova TN, Koval OA. Comparative assessment of methods used for predicting efficiency of lumbar sympathectomy in patients with lower-limb critical ischaemia. Angiology and Vascular Surgery. 2009;15(1):138-41. Russian.

Egorova NN, Guillerme S, Gelijns A, Morrissey N, Dayal R, McKinsey JF, et al. An analysis of the outcomes of a decade of experience with lower extremity revascularization including limb salvage, lengths of stay, and safety. J Vasc Surg. 2010 Apr;51(4):878-85, 885.e1. doi: 10.1016/j.jvs.2009.10.102. Epub 2010 Jan 4. PMID: 20045618.

Wong G, Li JM, Hendricks G, Eslami MH, Rohrer MJ, Cutler BS. Inhibition of experimental neointimal hyperplasia by recombinant human thrombomodulin coated ePTFE stent grafts. J Vasc Surg. 2008 Mar;47(3):608-15. doi: 10.1016/j.jvs.2007.11.025. PMID: 18295112.

Powell RJ, Simons M, Mendelsohn FO, Daniel G, Henry TD, Koga M, et al. Results of a double-blind, placebo-controlled study to assess the safety of intramuscular injection of hepatocyte growth factor plasmid to improve limb perfusion in patients with critical limb ischemia. Circulation. 2008 Jul 1;118(1):58-65. doi: 10.1161/CIRCULATIONAHA.107.727347. Epub 2008 Jun 16. PMID: 18559703.

Kosenkov AN, Cherepanin AI, Udovichenko SV. Hronicheskaya kriticheskaya ishemiya nizhnih konechnostey i saharnyiy diabet u lits pozhilogo i starcheskogo vozrasta. Klin. gerontol. 2007;5:34-8.[In Russian].

Lachmann N, Nikol S. Therapeutic angiogenesis for peripheral artery disease: stem cell therapy. Vasa. 2007 Nov;36(4):241-51. doi: 10.1024/0301-1526.36.4.241. PMID: 18357916.

Salyutin RV. Using cell indirect revascularization for chronic limb ishemia. Bukovinian Medical Herald. 2014;18(1):95-8. Ukrainian. doi: 10.24061/91610.

Poliachenko YuV, Salutin RV, Palianitsa SS, Martynenko SI, Sokolov NF, Shablyi VA, et al. Efficiency of transplantation of progenitory cells of fetal liver as method of indirect revascularization of inferior limbs. Medicine today and tomorrow. 2011;(1–2):237-41. Ukrainian.

Grigorian AS, Shevchenko KG. Some possible molecular mechanisms of vegf encoding plasmids functioning. Cell transplantation and tissue engineering. 2011;6(3):24-8. Russian.

Voronov DA, Gavrilenko AV, Bochkov NP. Stimulation of angiogenesis in improving the results of surgical treatment of patients with chronic lower limb ischemia: experimental substantiation and clinical efficacy. Diseases of the aorta and its branches. 2009;(3):45–8. Russian.

Hrin VK, Popandopulo AH, Stutin OA. Ways to stimulate indirect revascularization in the treatment of chronic ischemia of the lower extremities. Practical medicine. 2008;14(5):35–8. Ukrainian.

Kuharchuk AL, Radchenko VV, Sirman VM. Stem cells: experiment, theory, clinic. Embryonic, mesenchymal, neural and hematopoietic stem. Kyiv: Medical technologies; 2004. 504 p. Russian. ISBN 966-8029-76-3.

Delp MD, Colleran PN, Wilkerson MK, McCurdy MR, Muller-Delp J. Structural and functional remodeling of skeletal muscle microvasculature is induced by simulated microgravity. Am J Physiol Heart Circ Physiol. 2000 Jun;278(6):H1866-73. doi: 10.1152/ajpheart.2000.278.6.H1866. PMID: 10843883.

Published
2021-07-28
How to Cite
Ivanova, Y. V., Kryvoruchko, I. A., Prasol, V. A., Miasoiedov, K. V., & Andreieshchev, S. A. (2021). Indirect revascularization in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus. Klinicheskaia Khirurgiia, 88(3-4), 21-27. https://doi.org/10.26779/2522-1396.2021.3-4.21
Section
General Problems of Surgery

Most read articles by the same author(s)