RESUMO
The results of treatment of 53 patients, suffering "unreconstructable" affection of the lower extremities (LE) arteries and ulcerative-necrotic defects in their distal parts tissues, were analyzed. In 33 patients (the main group) the allotted mononuclear cells fraction, the bone marrow and the plasm, enhanced by thrombocytes, were applied, using multiple injections along a perimeter and into the bottom of the ulcerative-trophic defect in combination with autotransplantation of the bone marrow aspirate into the ischemized tissues--the shin muscles; in 20 patients (the comparison group)--the autotransplantation of the bone marrow aspirate was accomplished into the ischemized tissues--the shin and the foot muscles. In terms up to 3 mo postoperatively a clinical improvement in the main group was noted in 25 (75.7%) patients, the bearing function of the LE was preserved in 90.9%; and in the comparison group--accordingly, in 8 (40%) and 70%. In 36 mo in the main group the bearing function of the LE was preserved in 75.7% patients, and in the comparison group--in 50%. Application of the biotechnological methods proposed in patients, suffering ulcerative-necrotic defects in chronic ischemia of the LE tissues, have promoted the angiogenesis processes activation, the tissues reparation and regeneration, the wounds healing, and the disease clinical course optimization.
Assuntos
Angioplastia/métodos , Transplante de Medula Óssea , Terapia Baseada em Transplante de Células e Tecidos/métodos , Úlcera do Pé/terapia , Isquemia/terapia , Idoso , Doença Crônica , Feminino , Úlcera do Pé/patologia , Úlcera do Pé/cirurgia , Humanos , Isquemia/patologia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético , Neovascularização Fisiológica , Transplante Autólogo , CicatrizaçãoRESUMO
The purpose of the work--the choice of optimal treatment tactics of patients at the extremity tissue ischemia due to nonspecific aortoarteritis (NA). In the surgical treatment of patients with NA, particularly with concomitant peripheral lesions, and to a greater degree of terminal arterial bed, significantly limited the possibility of direct revascularization. Conservative treatment and subthoracal sympathectomy are ineffective. Autotransplantation of mesenchymal stem cells (MSCs), adipose tissue or bone marrow in ischemic tissue in the form of aspirates or selected from these aspirates cell cultures allowed to correct hemodynamic disorders by stimulating angiogenesis and development of collateral circulation.
Assuntos
Tecido Adiposo/transplante , Arterite/terapia , Transplante de Medula Óssea , Transplante de Células-Tronco Mesenquimais , Neovascularização Fisiológica , Tecido Adiposo/citologia , Aorta/patologia , Arterite/patologia , Contraindicações , Feminino , Humanos , Pessoa de Meia-Idade , Simpatectomia , Transplante Autólogo , Procedimentos Cirúrgicos VascularesRESUMO
Basing on experiments, performed on laboratory animals, and on the literature data, there was proved stimulating influence of transplantation of stromal cells, residing in adipose tissue, in a kind of stromal-adiposal fraction towards angiogenesis and reparative processes in tissues in ischemic conditions. There was elaborated and introduced the tactics of treatment in patients, suffering chronic ischemia of the lower extremities tissues, using combined methods of surgical treatment, including the bone marrow aspirate (BMA) autotransplantation into the ischemized tissues, the rotation ostheotrepanation, reconstructive and endovascular interventions on proximal segment of the extremity. The efficacy and potential of application of the BMA and adipose tissue was proved in the treatment of patients, suffering ischemia of the upper extremities tissues, caused by thromboobliterating affection of peripheral vascular bed.
Assuntos
Tecido Adiposo/transplante , Isquemia/cirurgia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Doenças Vasculares Periféricas/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Tecido Adiposo/citologia , Terapia Combinada , Humanos , Isquemia/terapia , Neovascularização Fisiológica , Doenças Vasculares Periféricas/terapia , Transplante Autólogo , Resultado do TratamentoAssuntos
Transplante de Medula Óssea/métodos , Misturas Complexas/uso terapêutico , Úlcera da Perna/terapia , Necrose/terapia , Retalhos Cirúrgicos , Tecido Adiposo/química , Misturas Complexas/isolamento & purificação , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/patologia , Perna (Membro)/cirurgia , Úlcera da Perna/patologia , Úlcera da Perna/cirurgia , Masculino , Necrose/patologia , Necrose/cirurgia , Fibrina Rica em Plaquetas/química , Plasma Rico em Plaquetas/química , Artéria Poplítea/patologia , Artéria Poplítea/cirurgia , Pele Artificial , Transplante Autólogo , Resultado do Tratamento , Adulto JovemRESUMO
An optimal tactics of treatment of patients, suffering the upper extremities (UE) ischemia, caused by arterial thrombosis, occurred due to subclavian artery damage in those patients, who apply crutches for a long period of time, was elaborated. In modern medicine in patients with the UE arterial bed thrombosis with affection of its peripheral, and more in terminal, portion the possibilities of direct revascularization performance are significantly restricted, especially in patients, suffering from constant mechanical injury of armpit and its vascular content, caused by crutches. Application of the method, consisting of automyelotransplantation of the bone marrow aspirate, have permitted to regulate the disorders of microhemodynamics, using stimulation of angiogenesis and development of a collateral blood flow.
Assuntos
Braço/irrigação sanguínea , Transplante de Medula Óssea/métodos , Artéria Braquial/lesões , Circulação Colateral/fisiologia , Muletas/efeitos adversos , Neovascularização Fisiológica/fisiologia , Trombose/cirurgia , Braço/diagnóstico por imagem , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Trombose/diagnóstico , Trombose/fisiopatologia , Resultado do Tratamento , UltrassonografiaRESUMO
In 55 patients, suffering obliterating atherosclerosis and chronic arterial insufficiency, there was accomplished autotransplantation of the bone marrow aspirate (ABMA) because of impossibility of conduction of direct revascularization of the lower extremity in inoperable or operable in question affection of the distal vascular bed, as a monomethod or in simultant fashion with reconstructive operations on proximal segments of vascular bed or using the other methods of indirect revascularization. After the operation in 63.1% of patients it appeared possible to preserve the "lean on" function of the lower extremity in early period and in 52.6%--in the remote period. The ABMA method application had permitted to correct microhemodynamical disorders by stimulation of angiogenesis and development of collateral blood flow in patients, suffering chronic ischemia of lower extremities, especially in the critical ischemia stage.