Critical limb ischemia

The term “critical limb ischemia” was first introduced by PRF Bell in 1982 to describe a group of diseases, associated with pain in the legs at rest, trophic ulcers and distal necrosis of the lower extremities. Critical limb ischemia is a state of almost complete cessation of arterial blood flow to the tissues of the lower extremities. The main diseases, that can cause critical ischemia of the lower limbs, is atherosclerosis, thromboangiitis and occlusive disease (inflammation of the arteries), diabetic angiopathy. In young age diabetes mellitus (especially type I) often causes limb ischemia and the immune-mediated vascular disease, and in old age – diabetes mellitus type II and atherosclerosis are the frequent causes of the disease.

Due to the severe atherosclerotic vascular damage in the affected area, the hydrodynamic pressure is reduced. The insufficient blood flow causes necrosis of skin and muscles of the legs, leading to the formation of non-healing wounds.

Patients with critical ischemia of the lower limbs suffer from intensive pain in the legs, which increases during walking and the patients lose the freedom of movement. In severe cases, the pain begins to torment even at rest, the ulcer or gangrene can develop. The term “critical ischemia” is used, when the mentioned above symptoms last for more than 2 weeks. If blood circulation is not improved, amputation becomes inevitable for all of such patients.

Because of the prevalence of this disease among people of working age and inefficiency of conventional treatment, critical limb ischemia is considered to be an extremely important medical and social problem in the world. All patients with critical limbs ischemia should be quickly directed to specialized centers for appropriate treatment. Surgery for critical limb ischemia is aimed at the preservation of the limb, and sometimes also the patient’s life.

Treatment of lower limb ischemia should be comprehensive and differentiated, depending on the stage and the characteristics of the disease. Current approaches to the treatment of lower limb ischemia include conservative and surgical treatments, all aimed at improvement of the blood flow in the affected limbs. The purpose of medical treatment of lower limb ischemia is the relief of ischemic pain, improvement of blood rheology and microcirculation, healing of ischemic ulcers, increase of the patient’s activity, improvement of the quality of life. Surgical treatment of this disease includes reconstructive vascular surgery for the correction of arterial blood supply to the affected limb and implicate direct and indirect revascularization. However, the treatment, which is performed in patients with critical lower limbs ischemia, does not affect the cause and progression of atherosclerosis, but only provides a gain in time for the development of collaterals and adaptation of microcirculation, thus allowing to delay amputation.

Cell therapy in the treatment of lower limb ischaemia

Cell therapy is a novel and promising approach to the treatment of patients with lower limb ischaemia. The amazing ability of adult stem cells to transform into the cells of blood vessels, as well as such their products as various endothelial growth factors lead to the growth of new blood vessels (angiogenesis) in the extremity, affected by the atherosclerotic process. The clinical studies, carried out worldwide, proved the safety of application of the mononuclear cells from the bone marrow, peripheral or, preferably, umbilical cord blood for this purpose. The latter contains endothelial progenitor cells, found to be the most effective in the treatment of the diseases, caused by circulatory insufficiency (lower limb ischemia, myocardial infarction, etc.). There is evidence of the efficiency of cell therapy in the treatment of migrant thromboangiitis – Buerger’s disease.

The Institute of Cell Therapy in conjunction with the staff of the Coordination Center of Transplantation of Organs, Tissues and Cells of the Ministry of Health of Ukraine and Shalimov National Institute of Surgery and Transplantation developed a method of treatment of chronic lower limbs ischemia by means of the transplantation of hematopoietic and mesenchymal progenitor cells. In principle, the treatment is based on the use of the ability of stem cells to produce factors that stimulate the growth of new capillaries (angiogenesis) and blood vessels (vasculogenesis). In severe cases, when occlusion of magistral vessels occurs or in the case of the multiple occlusion of medium-caliber vessels, stem cell transplantation is performed locally along the obliterated arteries. In cases of lesions of the smaller vessels, or in the case of contraindications for surgery, the large doses of mesenchymal and hematopoietic progenitor cells are introduced in the systemic circulation.

The stem cells produce the network of the new collateral vessels, bypassing the constriction. The emergence of the new blood vessels result in the restoration of the blood flow, nutrition and oxygen supply of the lower extremities.

In 2011, the Institute of Cell Therapy in Ukraine received the State Patent number 56808 “Method of indirect revascularization of the lower extremity.” And in 2012, the Ministry of Health approved the method of treatment of the lower limbs ischemia, developed by the Institute of Cell Therapy, with the use of the cell preparation Angiostem, which is produced by the biotechnological laboratory of the Institute.

As a result, the treatment of critical limb ischemia with the use of stem cells results in the significant reduction or complete disappearance of pain in the legs, rapid healing of ulcers, so you will return to the normal walking ability. The main thing is to apply in time for the qualified help of the professionals of our clinic. We can help you to bring back the joy of life!

Clinical examples

Patient S., 67 years old, was admitted for treatment with complaints of pain, edema of the lower extremities, intermittent claudication (walking less than 100 m), numbness in the legs. The examination revealed the obliteration of main and secondary arteries of the lower extremities. The local transplantation of mesenchymal and hematopoietic stem cells was conducted.

3 months after the surgery,the patient noted significant improvement: pain and edema disappeared, walking distance increased to 300 m after 6 months, the patient is able to perform domestic work, easily rises to the 2nd floor and the distance, which he can pass without pain, increased to 1200 m

Patient N., 92 years old, was admitted to the clinic, complaining of constant debilitating pain in the lower extremities, edema of the legs. He could not walk and did not sleep because of severe pain. As the patient also suffered from heart disease, the surgery was not allowed and the patient was exposed to the systemic intravenous administration of high doses of hematopoietic and mesenchymal stem cells. 1 month after the transplantation the patient was doing well, the pain disappeared, he independently walks along his house, feels a surge of strength, marks a significant improvement in quality of life.

For prior consultation or any question, you can fill out a simple form and our doctors will contact you immediately.

Actually Institute of Cell Therapy under the auspices of the Coordination Centre of Transplantation of the Ministry of Health of Ukraine conducts cinical trials “Cell stimulation of angiogenesis in the compex treatment of patients with chronic limbs ischemia” and “Transpantation of the Preparation of Human Cryoconserved Umbilical Cord Blood Nucleated Cells in the Complex Treatment of Patients with Trophyc Ulcers of the Venous Ethiology”.

Consultation

Call or write, and our consultant will give comprehensive answers to all your questions.

consultation