[Therapeutic angiogenesis via plasma-free autologous platelet lysate (intermediate results of one-year follow-up)].

OBJECTIVE

To evaluate the effectiveness of conservative therapy supplemented by administration of plasma-free autologous platelet lysate in treatment of patients with chronic critical lower-limb ischemia if it was impossible to perform a reconstructive operation.

PATIENTS AND

METHODS

This study is a continuation of our previously initiated research in the field of therapeutic angiogenesis using plasma-free autologous platelet lysate. Analyzed herein are the results of treating a total of 96 patients with critical ischemia of the lower extremities. The patients were divided into two groups: Group I included 49 patients who received standard conservative therapy supplemented by administration of plasma-free autologous platelet lysate and Group II consisted of 47 patients who underwent standard conservative therapy. We assessed such alterations as relief of rest pain, limitation of the necrosis zone, and epithelization of trophic ulcers. Besides, we analyzed the findings of three-phase scintigraphy assessing changes of microcirculation accompanied by an increase in the radiopharmaceutical elimination index because namely this parameter is most sensitive in critical ischemia. The duration of the follow-up period was 12 months, with interim examinations carried out at 6 months.

RESULTS

The groups had no statistically significant differences in the main clinical and demographic indicators (p>0.05). A decrease in trophic ulcers was noted in 32 (65.3%) Group I patients and in 23 (48.9%) Group II patients, p=0.031; rest pain relief was noted in 25 (51.0%) Group I patients and in 17 (36.2%) Group II patients, p=0.024. In a number of Group I patients, three-phase scintigraphy performed again at 12 months showed improvement in tissue blood flow and an increase in the radiopharmaceutical elimination index. The amputation rate was higher in Group II (4.1%) than in Group I (2.0%), p=0.031, with no lethal outcomes observed.

CONCLUSION

In inoperable patients with chronic critical ischemia of the lower extremities, complex conservative therapy supplemented by administration of plasma-free autologous platelet lysate demonstrated better results than standard therapy over a 12-month follow-up period.