A Single Center Experience Using IVUS as an Adjunct in Nutcracker Syndrome

Abstract

Introduction: The limb amputation is an important cause of morbidity and mortality in short and long term , therefore any option to preserve the extremity is welcome. The aim of this study was to avoid the major amputation in patients without possibility of revascularization by therapy with Autologous Stem Cells Methods: Under epidural anaesthesia a total of 240 ml of Bone Marrow was obtained by direct puntion from the iliac bones and then the sample was centrifuged for 20 minutes , from this amount only 40 cc containing Autologous Stem Cells, was injected in the ischaemic leg guided with ultrasound as close as possible to the obliterated arterial tree at one cm intervale. Tuenty patients were included in this study, 4 with grade IV and 16 with grade III of the Fontaine classification. All of them candidates for a mayor amputation in a short therm. The following parameters were investigated before and after treatment : Pain scale, A.B.I and Angiography findings Results: Four of the patients (15%) that were in grade IV of Fontaine classification did not improve and underwent a mayor amputation, 16 patients (85%) experienced a steadily improvement coming out of the rest pain and avoiding mayor amputation, this improvement was demonstrated, clinically and radiologically. Conclusion: These results may open new possibilities of treatment to those patients otherwise condemned to a major amputation. Possibly is an ideal technique for patients with Buerguer's disease. This technique seems to be more effective when the patients are only in Grade 3 of the Fontaine classification.