Zelltransplantation bei chronischer Extremitätenischämie

Fazit

Die autologe Stammzelltherapie ist nach den bislang vorliegenden Studien ein möglicher neuer Ansatz in der Behandlung der pAVK. Erste Erfahrungen zeigen eine gute Praktikabilität und sehr gute Sicherheit der Therapie. Die vorliegenden Ergebnisse der überwiegend unkontrollierten Studien zeugen von einer Verbesserung der Durchblutung, einhergehend mit klinischer Verbesserung. Eine erfolgreiche Umsetzung in die Praxis hängt von den Ergebnissen größerer kontrollierter Untersuchungen ab, die zurzeit laufen.

Mit der Stimulation der Gefäßneubildung durch autologe Stammzellentransplantation ergeben sich in der Zukunft eventuell neue oder ergänzende Alternativen zu den bisherigen Konzepten der Behandlung der pAVK. Dies gilt vor allem für Patienten, bei denen eine progrediente Verschlechterung der Ischämie mit pharmakologischen Maßnahmen nicht verhindert werden kann und bei denen eine gefäßchirurgische oder interventionelle Revaskularisation nicht möglich ist. Die Erfahrungen der Autoren sind ermutigend; bei sorgfältiger Selektion der Patienten (erhaltungswürdige Extremität, noch messbare Restdurchblutung mit einem Knöchel-Arm-Index von mehr als 0,1 und einem transkutanen Sauerstoffpartialdruck von über 0 mmHg) ist die technisch dank der Automatisierung und der bettseitigen Durchführbarkeit einfach gewordene autologe Zelltherapie eine gute Möglichkeit, um Majoramputationen zu verhindern.

• Literatur

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