Fedzianin S.D.1, Kovalenko A.A.1, Kamiandrouskaya A.A.1, Poluyanchik E.A.2, Denisenko A.G.1
Revascularizing automyelotransplantation in complex treatment for diabetic angiopathy of the lower limbs
1Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
2Vitebsk City Central Clinical Hospital, Vitebsk, Republic of Belarus
Vestnik VGMU. 2019;18(1):46-51.
Objectives. To develop the method of indirect revascularization of the lower extremities, based on the use of autotransplantation of bone marrow aspirate.
Material and methods. The method of indirect revascularization of the lower extremities based on the use of autoaspirate of the red bone marrow – revascularization automyelotransplantation (RAMT) has been developed and introduced. Under the local anesthesia a sternal puncture is performed using the needle of I.A. Kassirsky and the red bone marrow is sampled. Local anesthesia is performed at the point of injection of aspirates on the thigh and shin with the subsequent bone marrow aspirate replantation by its insertion into the thigh and shin muscles. An aseptic dressing is applied. 23 patients suffering from diabetes mellitus with chronic arterial insufficiency of the 3rd b-4th stages were operated on. In all cases there were no indications for performing reconstructive operations on the great vessels. Conservative treatment as well as local treatment of wounds were carried out according to generally accepted patterns. The control group consisted of patients (32 people) suffering from diabetes mellitus with chronic arterial insufficiency of the 3rdb-4th stage receiving only conservative treatment.
Results. In the early postoperative period all patients with the carried out RAMT showed positive results. It was possible to avoid high amputation of the lower extremities in 90,9% of patients at the time of observation up to 18 months. In the comparison group this index was 65,0% (p<0,05). There was an increase in the distance of painless walking. In the main group out of 18 patients trophic disorders disappeared after surgery in 3 cases and 5 patients had no negative dynamics. A good and satisfactory quality of life was noted by 92.3% of patients with the carried out RAMT.
Conclusions. The proposed method can be used for indirect revascularization of the lower extremities in the complex treatment of patients with diabetic angiopathy. The use of RAMT enabled the avoidance of high amputation of the lower limb in 90,9% of patients within the period of 18 months. A tendency towards the increase in the distance of painless walking and the improvement of life quality of patients was seen.
Key words: diabetes mellitus, indirect revascularization, chronic arterial insufficiency.
1. Eroshkin SN, Bulavkin VP. Diabetic foot syndrome: clinic, diagnostics, treatment: posobie. Vitebsk, RB: VGMU; 2016. 56 р. (In Russ.)
2. Salyutin RV, Buslovich EV, Sirman VM, Boris RN, Komarova LS, Palyanitsa SS. The use of cellular technology in the treatment of chronic ischemia of the lower limbs. Ukr Med Chasop. 2012;(12):27-9. (In Russ.)
3. Хірургія Dryuk NF, Kirimov VI, Barna IE, Dmitrenko IP, Shkuropat VN. Application of autologous aspirates, as well as multipotent stromal cells of bone marrow and adipose tissue in vascular surgery. Klіn Khіrurgіia. 2012;(12):24-9. (In Russ.)
4. Mazo M, Cemborain A, Gavira JJ, Abizanda G, Araña M, Casado M, et al. Adipose stromal vascular fraction improves cardiac function in chronic myocardial infarction through differentiation and paracrine activity. Cell Transplant. 2012;21(5):1023-37. doi: http://dx.doi.org/10.3727/096368911X623862
5. Medina RJ, O'Neill CL, Humphreys MW, Gardiner TA, Stitt AW. Outgrowth endothelial cells: characterization and their potential for reversing ischemic retinopathy. Invest Ophthalmol Vis Sci. 2010 Nov;51(11):5906-13. doi: http://dx.doi.org/10.1167/iovs.09-4951
6. Wu R, Su N, Zhang Z, Jia F. Treatment of Moyamoya disease by multipoint skull drilling for indirect revascularization combined with mobilization of autologous bone marrow stem cells. Genet Mol Res. 2015 Jul;14(3):7519-28. doi: http://dx.doi.org/10.4238/2015.July.3.27
7. Barclay GR, Tura O, Samuel K, Hadoke PW, Mills NL, Newby DE, et al. Systematic assessment in an animal model of the angiogenic potential of different human cell sources for therapeutic revascularization. Stem Cell Res Ther. 2012 Jul;3(4):23. doi: http://dx.doi.org/10.1186/scrt114
8. Dryuk NF, Kirimov VI. Revascularizing surgeries at obliterating lesions of shin and foot arteries in patients with chronic critical ischemia of lower limbs. Klіn Khіrurgіia. 2007;(5-6):48-9. (In Russ.)
9. Grin' VK, Shtutin AA, Popandopulo AG, Basatskiy AV, Varshaver PL. Autotransplantation of stromal stem cells in the treatment of obliterating diseases of lower limb arteries. Vestn Neotlozh Vosstanov Meditsiny. 2010;11(4):512-3. (In Russ.)
10. Buka GYu, Chayka OO, Stroilo AB, Chayka OO, Glazunov VK, Nekrasov SYu, i dr. Modern aspects of treatment of patients with distal vascular insufficiency. Ukr Zhurn Ekstrem Meditsiny іm GO Mozhaєva. 2013;14(2):113-7. (In Russ.)
11. Ognerubov NA. Topographic and anatomical substantiation of sterile puncture: prevention of fatal complications. Vestn Tambov Un-ta Ser Estestv Tekhn Nauki. 2016;21(6):2206-10. (In Russ.)
Information about authors:
Fedzianin S.D. – Candidate of Medical Sciences, associate professor of the Chair of Hospital Surgery with the courses of Urology & Pediatric Surgery, Vitebsk State Order of Peoples’ Friendship Medical University;
Kovalenko A.A. – Candidate of Medical Sciences, associate professor of the Chair of Hospital Surgery with the courses of Urology & Pediatric Surgery, Vitebsk State Order of Peoples’ Friendship Medical University;
Kamiandrouskaya A.A. – lecturer of the Chair of Hospital Surgery with the courses of Urology & Pediatric Surgery, Vitebsk State Order of Peoples’ Friendship Medical University;
Poluyanchik E.A. – medical specialist in ultrasound diagnosing, Vitebsk City Central Clinical Hospital;
Denisenko A.G. – Candidate of Medical Sciences, associate professor of the Chair of Pathological Anatomy with the course of Forensic Medicine, Vitebsk State Order of Peoples’ Friendship Medical University.