PLACE OF THE THERAPEUTIC NEOANGYOGENESIS IN CRITICAL ISCHEMIA TREATMENT OF LOWER LIMBS

The choice of treatment method in patients with critical ischemia is one of tetopical issues of angio-surgery, since the possibility of the limb preservationarises. In this group of patients, performance of the directre vascularization of the extremitiesor endovascular angioplasty are limited due to the lack of blood flow in the trunk arteries. Theres torationofblood circulation, atleastattheminimumnecessary level, is animport ant task for the preservation of the limb. The following methods of indirectre vascularizatio nareused: surgical – denervati on interventions, stimulation of neoangiogenesis (perforating osteotrepanation), transplantati on of the large omentumon the limb and therapeutic neoangiogenesis – introduction of bone marrow mononuclear agents, genedrugs, plateletmix, andthelike. In this regard, stimulation of angiogenesis in an ischemic limb by injection of platelet-rich autoplasmausing PRGF®-ENDORET® technology (Platelet-rich Plasma-therapy) maybe one of the promising directions of the study. Purpose. The aimistogive clinical just ifi cation for theuse of auto- plasmaenriched with growth factors (PRGF®-ENDORET®) for treatment of patients with critical ischemia of the lower limbs. Methods.The results of the application of PRGF®-ENDORET® technologyin 25 patients with lower limbs ischemia have been analyzed.Among them there were 16 patients of the degree II of morbidity, groups four and 9 of the degree III of morbidity, the 5th group (according to Rutherford's classification et al., 1997).The average age of patients was 56.7 ± 9.3 years, all men.The average age of patients was 56.7 ± 9.3 years, all men.Taking into account the ultrasound data and angiography classification of TASC II type C was found in 11 patients, and type D in14 patients.Among them, four patients had hip-popliteal bypass surgery, and eight patients - endovascular balloon angioplasty.In operated patients, increasing limb ischemia was observed in the remote postoperative period because of the atherosclerotic process progression in the distal limb parts.For therapeutic neoangiogenesis, plasma enriched with growth factors was prepared according to the protocol of the Institute of Biotechnology BTI (Spain).Under the control of the ultrasound, every 2 ml of plasma enriched with growth factors (PRGF®-ENDORET®), was injected into the projection of the vessels of the shin.The manipulation was repeated in 10-14 days. Results. According to the results of the research data, within the period of 2-6 months, gradual improvement of the blood supply to the limb comes. Absence of any pain syndrome, significant increase in walking for long distances, and improve-ment of the microcirculation in the distal part of the limb ac-cording to the transcutaneous oximetry data indicate better health state of the patients.The positive effect of PRP therapy is also confirmed by positive changes in the clinical condition of the limb. Conclusion. The analysis of the results of PRP-therapy studies using PRGF®-ENDORET® technology shows that this method is a promising one in treatment of critical lower limb ischemia and can be used in complex treatment of critical ischemia or in preparation of patients for revascularization operations.