Kristina A. Giles, Philip P. Goodney, Eva M. Rzucidlo, Daniel B. Walsh, Richard J. Powell
Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
OBJECTIVES: Bone marrow aspirate injections (BMA) in the treatment of patients with critical limb ischemia (CLI) is a potential treatment option in poor candidates for standard revascularization procedures. While clinical trials are ongoing, there is little comparative data to assess its efficacy compared to bypass.
METHODS: Nineteen patients with poor revascularization options underwent BMA. Outcomes were compared to a cohort of 42 CLI patients undergoing infrainguinal bypass felt to be at high risk for graft failure (previous endovascular treatment or bypass, tibial target and tissue loss). BMA patients underwent harvest of 120-240ml of bone marrow then concentrated and injected intramuscularly into the ischemic limb.
RESULTS: BMA patients had a higher incidence of prior smoking (90% vs. 43%, p<0.05) with a trend toward fewer diabetics (47% vs. 71%, p=0.07). In the BMA cohort, 84% had rest pain and 79% had tissue loss. Sixty-eight percent had a prior bypass or endovascular intervention. Mean follow-up was 334 days (+/-170). A second BMA treatment was performed in 21% due to clinical deterioration. ABI improvement was 0.23 (+/-0.25). Rest pain improved in 87.5% and completely resolved in 56%. Wound healing occurred in 67%. Three patients went on to amputation (freedom from major amputation or death at 1.5 years 89% vs. 59% (Figure 1, p<0.05).
CONCLUSIONS: Bone marrow aspirate injection therapy is a potential option in CLI patients who are not candidates for bypass or endovascular intervention. Limb salvage is unexpectedly high in this population with few other options.
AUTHOR DISCLOSURES: K. A. Giles: Nothing to disclose; P. P. Goodney: Nothing to disclose; R. J. Powell: Aastrom Trial- PI for trial, Consulting fees or other remuneration (payment); E. M. Rzucidlo: Nothing to disclose; D. B. Walsh: Nothing to disclose.
Posted April 2013