Long-term Results of Surgical Treatment and Cell Therapy in Patients with Type 2 Diabetes and Chronic Lower Limb Ischemia

Chronic ischemia of the lower extremities is one of the main problems of modern health care. This condition in patients with type 2 diabetes is characterized by a high risk of limb loss and pricey treatment costs. Surgical revascularization is considered the optimal treatment. Conservative treatment is important in the postoperative period, as well as in case of impossibility of performing surgical intervention. However, in many cases, drugs are ineffective, and the options for surgical revascularization are limited, which increases the risk of limb amputation. One of the treatments for peripheral arterial disease is therapy with autologous bone marrow mononuclear cells injected intramuscularly into the affected limb. By increasing the rate of ulcer healing in patients with and without diabetes, the method can reduce the frequency of amputations. The article compares the long-term results of endovascular revascularization and its combination with the use of autologous mononuclear cells. The number of amputations, mortality and effectiveness of conservative therapy were determined. The state of the arterial bed of the lower extremities was assessed by the ankle-brachial index and transcutaneous oxygen tension data. It is concluded that the combination of surgical treatment and cell therapy does not have a statistically significant effectiveness in comparison with isolated surgical treatment. There were no significant differences in the number of amputations and mortality between the two groups. However, patients receiving conservative therapy (antiplatelet agents, statins, anticoagulants, etc.) according to the scheme and in full, as a result, have the highest transcutaneous oxygen tension in the tissues of the lower extremities, which indicates the importance of prescribing adequate drug therapy and observing in patients with chronic ischemia of the lower extremities.