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. 2011;4(1):24-31.
doi: 10.3400/avd.oa.10.01049. Epub 2011 Feb 17.

Prediction of limb salvage after therapeutic angiogenesis by autologous bone marrow cell implantation in patients with critical limb ischemia

Shuhei Tara  1 , Masaaki Miyamoto, Gen Takagi, Yoshimitsu Fukushima, Sonoko Kirinoki-Ichikawa, Hitoshi Takano, Ikuyo Takagi, Hiroshi Mizuno, Masahiro Yasutake, Shinichiro Kumita, Kyoichi Mizuno
Affiliations

Prediction of limb salvage after therapeutic angiogenesis by autologous bone marrow cell implantation in patients with critical limb ischemia

Shuhei Tara et al. Ann Vasc Dis. 2011.

Abstract

Purpose: Despite advances in therapeutic angiogenesis by bone marrow cell implantation (BMCI), limb amputation remains a major unfavorable outcome in patients with critical limb ischemia (CLI). We sought to identify predictor(s) of limb salvage in CLI patients who received BMCI.

Materials and methods: Nineteen patients with CLI who treated by BMCI were divided into two groups; four patients with above-the-ankle amputation by 12 weeks after BMCI (amputation group) and the remaining 15 patients without (salvage group). We performed several blood-flow examinations before BMCI. Ankle-brachial index (ABI) was measured with the standard method. Transcutaneous oxygen tension (TcPO2) was measured at the dorsum of the foot, in the absence (baseline) and presence (maximum TcPO2) of oxygen inhalation. (99m)technetium-tetrofosmin ((99m)Tc-TF) perfusion index was determined at the foot and lower leg as the ratio of brain.

Results: Maximum TcPO2 (p = 0.031) and (99m)Tc-TF perfusion index in the foot (p = 0.0068) was significantly higher in the salvage group than in the amputation group. Receiver operating characteristic (ROC) curve analysis identified maximum TcPO2 and (99m)Tc-TF perfusion index in the foot as having high predictive accuracy for limb salvage.

Conclusion: Maximum TcPO2 and (99m)Tc-TF perfusion index in the foot are promising predictors of limb salvage after BMCI in CLI.

Keywords: 99mtechnetium-tetrofosmin perfusion scintigraphy; bone marrow cell implantation; critical limb ischemia; limb salvage; transcutaneous oxygen tension.

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Figures

Fig. 1
Fig. 1
Ankle brachial index before bone marrow cell implantation.
Fig. 2
Fig. 2
Transcutaneous oxygen tension (TcPO2) measurements at ambient conditions (A: baseline TcPO2) and during 5 min of pure oxygen inhalation at 5 mL/min (B: maximum TcPO2).
Fig 3
Fig 3
Representative image of 99mTc-TF perfusion scintigraphy. Arrow-heads indicate lower leg region, and arrows indicate foot region of ischemic leg.
Fig. 4
Fig. 4
Tissue blood flow estimated by 99mTc-TF perfusion scintigraphy (99mTc-TF perfusion index: expressed as muscle to brain [M/B] ratio of mean counts per pixel). Lower leg region (A) and foot region (B).
Fig. 5
Fig. 5
Kaplan-Meier plots of time to major limb amputation dichotomized at the cut-off values of maximum TcPO2 (A) and 99mTc-TF perfusion index in the foot region (B).
See this image and copyright information in PMC

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