Peripheral artery disease is a common condition in patients on chronic dialysis treatment, end-stage kidney failure itself being a risk factor. The most severe stage of peripheral artery disease, critical limb ischemia, causes marked chronic pain and is associated with risk of limb loss. Despite improvements in revascularization procedures, the results of limb salvage procedures among dialysis patients remains poor, and lower extremity amputation is associated with high mortality and grim socio-economic implications. We report on a limb salvage approach that was successfully employed in a 74-year-old woman on hemodialysis suffering from no-option critical limb ischemia complicated by diabetic foot infection, i.e. otherwise a candidate for major amputation. The approach consists in implanting in the wound bed of the affected limb a concentrate of autologous peripheral blood mononuclear cells collected from the peripheral blood of the patient using a selective filtration separation system. The procedure, performed by a vascular surgeon in an outpatient setting and sterile conditions, was repeated three times at intervals of 15 days, and was well tolerated; no adverse safety signals were observed. Complete wound healing was obtained, with successful limb rescue.
Keywords: Diabetic foot; Hemodialysis; No option-critical limb ischemia; Peripheral blood mononuclear cell therapy.
© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.