Prediction of Limb Salvage after Therapeutic Angiogenesis by Autologous Bone Marrow Cell Implantation in Patients with Critical Limb Ischemia

Abstract

Purpose: Despite advances in therapeutic angiogenesis by bone marrow cell implantation (BMCI), limb amputation remains a major unfavorable outcome in patients with critical limb ischemia (CLI). We sought to identify predictor(s) of limb salvage in CLI patients who received BMCI.
Materials and Methods: Nineteen patients with CLI who treated by BMCI were divided into two groups; four patients with above-the-ankle amputation by 12 weeks after BMCI (amputation group) and the remaining 15 patients without (salvage group). We performed several blood-flow examinations before BMCI. Ankle-brachial index (ABI) was measured with the standard method. Transcutaneous oxygen tension (TcPO₂) was measured at the dorsum of the foot, in the absence (baseline) and presence (maximum TcPO₂) of oxygen inhalation. ^99mtechnetium-tetrofosmin (^99mTc-TF) perfusion index was determined at the foot and lower leg as the ratio of brain.
Results: Maximum TcPO₂ (p = 0.031) and ^99mTc-TF perfusion index in the foot (p = 0.0068) was significantly higher in the salvage group than in the amputation group. Receiver operating characteristic (ROC) curve analysis identified maximum TcPO₂ and ^99mTc-TF perfusion index in the foot as having high predictive accuracy for limb salvage.
Conclusion: Maximum TcPO₂ and ^99mTc-TF perfusion index in the foot are promising predictors of limb salvage after BMCI in CLI.