| 발표형식 : 구연
|
접수번호 - 470644 235 |
| Autologous transplantation of bone-marrow cells in ischemic limbs of Buerger��셲 disease : Early results |
| Division of Cardiology쨔 and Hematology짼, Deptartment of Internal Medicine, Thoracic and Cardiovascular Surgery쨀, Laboratory Medicine�겢and Anesthesiology5, Cardiovascular Research Institute6, Yonsei University College of Medicine |
| Young-Guk Ko쨔, Donghoon Choi쨔, Yangsoo Jang쨔, Ki-Cheol Hwang6, June-Won Cheong짼 , Seung Tae Lee짼 , Yoo Hong Min짼 , Sang-Hyun Lim쨀, Kyung-Jong Yoo쨀, Hyun-Ok Kim�겢, Young Ran Kwak5 |
Background : Buerger��셲 disease is known as an agonizing non-atherosclerotic inflammatory disease affecting small vessels and most prevalent in young-aged smoking males. However, no conventional therapy has been satisfactory. We investigated the safety and efficacy of autologous bone marrow cell implanatation in ischemic limbs of Buerger��셲 disease Methods : Ten male patients (age: 38.5짹5.34 years) with Buerger��셲 disease of Rutherford class II (n=2) and III (n=8), inappropriate candidates for PTA or bypass surgery, were enrolled. Bone marrow cells (volume : 665.7짹52.8 mL) were aspirated under general anesthesia. We sorted mononuclear cells and concentrated them into a volume of 30 mL (total WBC 5.96 x 109, mononuclear cell 1.34 x 109, CD34+ 3.93 x 107, AC133+ 2.04 x 107). We implanted 0.5 mL of concentrated bone marrow cells into each injections site of ischemic limb. We performed modified walking impairment questionnaire (WIQ), rest pain scale assessment, treadmill test for absolute claudication distance (ACD), plethysmography, digital infrared thermographic imaging (DITI), and angiogram before and 1 month after the implantation of bone marrow cells. Results : Baseline evaluation showed relatively well preserved ABI (0.78짹0.12) and ACD (>800m in 7 patients) despite rest pain, pedal ulcer or gangrenous change. At 1- month follow-up, there was no significant change in ABI or ACD. However, symptoms were improved : the WIQ score rose from 31.6짹12.1 at baseline to 41.3짹12.2 at 1 month (p=0.008), and the rest pain score decreased from 2.4짹1.3 to 1.2짹0.8 (p=0.005). Improved wound healing was reported by all patients with ulcer or gangrene. DITI showed the temperature difference between the ischemic and the contralateral limbs was reduced after the treatment (from 1.21짹1.04째C to 0.36짹0.31째C, p=0.049). A follow-up angiogram showed mild new collateral formation in 4 patients.
Conclusion : Autologous implantation of bone marrow-mononuclear cells was safe and improved symptoms and wound healing of critical limb ischemia in Buerger��셲 disease. A larger study with long-term follow-up is needed to validate these results.
|
|
|
|
|
