History and clinical findings: A 62-year-old man had limb ischemia in stage IIb (Fontaine's classification). After surgical and interventional measures the right superficial femoral artery had remained occluded for more than one year. The patient's walking distance was only 100 meters. It was therefore decided to do a combined intraarterial and intramuscular transplantation of stem cells into the right limb.
Investigations: Before and 10 weeks after the transplantation noninvasive tests, namely walking distance, ankle-brachial index at rest and during exercise, occlusion plethysmography and capillary venous oxygen saturation were measured. The patient was also asked to fill in a questionnaire of his symptoms.
Therapy and results: After harvesting the patient's bone marrow the mononuclear cell fraction was separated (109.8 x 10(6)). Afterwards 10 ml of the cell suspension were injected into the right superficial femoral artery and 5 ml each of the suspension was injected into 5 different locations of the quadriceps femoris and the gastrocnemius muscles. After 10 weeks" follow-up a seven-fold improvement of walking distance and an increase of tissue oxygen saturation of more then 50% were recorded. The ankle-brachial index at rest remained unchanged, but on exercise it increased by 24%.
Conclusion: The combined intraarterial and intramuscular transplantation of human autologous bone marrow stem cells may be a novel and clinically feasible treatment for patients with severe chronic limb ischemia. The success of this approach may be the result of increased neo-angiogenesis, especially of the small muscle-supplying vessels.