CLINICAL EFFECTIVENESS OF REVASCULARIZING AUTOMYELOTRANSPLANTATION

Background. The Global Vascular Guidelines (2019) proposed the term “critical limb-threatening ischemia”, which leads to death or amputation within 12 months. Only half of the patients undergo limb revascularization; the rest receive conservative treatment, the effectiveness of which is extremely low. In this regard, it is necessary to develop alternative methods of surgical treatment based on the use of cellular technologies. Aim. To evaluate the clinical efficacy of revascularizing automyelotransplantation in the complex treatment of patients with chronic wounds associated with diabetic angiopathy of the lower extremities. Material and methods. The study included 100 patients suffering from diabetic angiopathy of the lower extremities and diabetes mellitus type 2. Chronic wounds of the lower extremities were detected in 25 patients of the main group and 32 patients in the comparison group. The size of chronic wounds in the main group before the start of treatment ranged from 0.5 to 3.5 cm2 (median (Me) 2.1 [1.5; 2.5] cm2), in the comparison group it varied from 0.7 to 3.5 cm2 (Me 2.1 [1.7; 2.6] cm2). There were no statistical differences between the groups (pMann-Whitney=1.0). Results. In the main group, chronic wounds healed in 12 patients (48%), decreased in size in three cases and remained without dynamics in one case. In six patients the purulent-necrotic process progressed, which led to amputation of the limb at the hip level. Three patients died. Among 32 patients with chronic wounds in the comparison group healing of chronic wounds or reduction in their size were not observed. In 10 people, the size of the defects did not change; in seven cases the purulent-necrotic process progressed, which led to the amputation of the limb. In two patients chronic wounds occurred after hospitalization. Fifteen patients died. The article presents descriptions of clinical cases. Conclusion. The use of revascularizing automyelotransplantation in the complex treatment of patients with diabetic angiopathy of the lower extremities has a positive effect on the dynamics of the wound process in chronic wounds.