Introducere: Cercetarile preclinice au relevat efectul pozitiv al injectarilor in tesuturile moi a concentratului trombocitar autolog (CTA) asupra stimularii neovascularizarii. Scopul studiului: evaluarea sigurantei si eficacitatii clinice a injectarilor CTA la pacientii cu diabet zaharat, ischemie cronica critica a extremitatilor inferioare si patologie arteriala periferica inoperabila. Metode: In studiu au fost inclusi 20 de bolnavi cu diabet tip II (virsta medie – 67 ani) si durere in repaus (13; 65%) sau ulcer plantar ischemic (7; 35%). In toate cazurile leziunile arteriale au fost calificate ca inoperabile in baza datelor ecografiei duplex si CT-angiografiei. Cu anestezie i/v sau spinala CTA a fost injectat in tesuturile moi ale membrului afectat in volum mediu de 58 ml (50-75 ml) per extremitate. Procedura s-a repetat peste o saptamina. Severitatea durerii in membrul ischemic si rata vindecarii ulcerelor au fost monitorizate timp de 6 luni. Rezultate: Nu au fost inregistrate complicatii majore asociate cu injectarea CTA. Opt pacienti au raportat o amplificare tranzitorie (2-3 zile) a durerii in regiunile injectarii. La finele evaluarii ameliorarea clinica a fost inregistrata la 16 (80%) bolnavi: disparitia completa a durerii in repaus - in 4 si diminuarea severitatii durerii - in 12 cazuri. Printre acesti bolnavi valoarea medie a scorului vizual analog a fost 5,4 vs 7,2 la debutul studiului (p<0,05). Trei pacienti nu au indicat modificarea severitatii durerii. Vindecarea ulcerului plantar a fost observata in 5/7 (71,4%) cazuri. Doar o amputatie (de gamba) a extremitatii a fost efectuata din cauza persistentei durerii intense in repaus. Concluzii: Experienta clinica initiala demonstreaza potentiala eficacitate a injectiilor in tesuturile moi a CTA in tratamentul bolnavilor cu planta diabetica ischemica. Injectarea CTA reprezinta o procedura sigura si simpla ce poate fi o alternativa terapeutica pentru pacientii cu patologii arteriale periferice inoperabile.

Introduction: Preclinical studies conclude about the positive effect of platelet-rich plasma (PRP) soft tissues injections upon stimulation of neovascularization. The aim of study was assessment of safety and clinical efficacy of autologous PRP injections in patients with diabetes mellitus, chronic critical lower limb ischemia and unreconstructible peripheric arterial disease. Materials and Methods: Twenty patients with type II diabetes (mean age – 67 years) and rest pain (13; 65%) or ischemic lower limb ulcers (7; 35%) were enrolled in study. In all cases arterial lesions were classified as unreconstructible basing on data of duplex ultrasound and CT- angiography. The PRP was consecutively injected in the soft tissues of the affected limb under intravenous or spinal anesthesia. The average volume of injected PRP was 58 ml (50-75 ml) per limb. Procedure was repeated after one week. Severity of pain in ischemic limb and healing rate of ulcers were monitored during 6 months. Results: There were no major complications associated with PRP injections. In 8 cases a transient (2-3 days) increasing of pain in the region of injections were reported by patients. At the end of follow-up, clinical improvement was registered in 16 (80%) patients: complete disappearance of rest pain in 4 and decreasing of pain severity in 12 cases. Among this patients the mean value of visual analogue scale was 5,4 vs 7,2 at the beginning of study (p<0,05). Three patients report no change in severity of pain. Healing of ischemic foot ulcer was observed in 5/7 (71,4%) cases. Only one below knee amputation was performed due to intractable rest pain. Conclusions: Initial clinical experience demonstrates the potential efficacy of soft tissue injections of autologous PRP in the treatment of patients with ischemic diabetic foot. PRP injections are safe and simple procedure that can be used as alternative therapeutic approach in patients with unreconstructible peripheric arterial disease.