Bone marrow mononuclear cell implantation as an effective therapeutic option for the untreatable critical limb ischemia patient with endovascular therapy

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Kan Zen, MD
ISEVS Japan Chapter
​Program Director

Department of Cardiovascular Medicine,
Kyoto Prefectural University of Medicine Hospital,
​Kyoto, Japan.

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Clinical History

This is a 58-year-old male with a long history of Buerger’s disease (18 years). He has stopped smoking completely when he has been diagnosed. He presented with rest pain in the left leg and non-healing ulcers on his left first and fifth toe. His left ankle brachial index (ABI) was measured at 0.79 and skin perfusion pressure (SPP) was 14 mmHg around wound. Anterior and posterior tibial and peroneal artery was occluded and the artery above the knee was patent. Two times of endovascular therapy failed and hyperbaric oxygen therapy was not effective in another hospital. Finally, he was admitted to our hospital for undergoing autologous bone marrow mononuclear cell (BM-MNCs) implantation therapy. 

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Procedure

Approximately 600ml of bone marrow was harvested from the bilateral iliac bones and mononuclear cells were separated with centrifuge. 3.48x109 of mononuclear cells were implanted using small needle injection into the muscle of the left lower limb and around the wound. 

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Conclusion

Rest pain was relieved from 6/10 to 4/10 by numerical rating scale one month after the BM-MNCs implantation. Three months after the BM-MNCs implantation, rest pain disappeared and visible healing of the first toe ulcer was observed. SPP also increased to 32 mmHg around wound. Six months after the BM-MNCs implantation, SPP increased to 42 mmHg around wound and the first toe ulcer was almost scabbing. Angiogenesis using BM-MNCs implantation might be one of options for no-option critical limb ischemia patients.