sirolimus and Leg-Ulcer

The study was designed as a feasibility trial to evaluate the use of GP IIb/IIIa blockade in connection with drug eluting stents, bare stents and PTA only. Sixty patients with current ulcers were randomly assigned to receive abciximab plus a sirolimus coated stent (N.=14), abciximab plus a bare stent (N.=16), abciximab plus PTA (N.=14) and PTA alone (N.=19). Angiographic control was performed at two and six months. Recanalization was successful in all cases. Two month restenosis rate was 9%, 45.5%, 67% and 46%. At six month follow-up restenosis rate was 9%, 67%, 75% and 58%, respectively; 14% of all patients had major amputations within six months. Adjunctive administration of abciximab during peripheral arterial intervention below the knee was found to be safe. Sirolimus coated stent administration was followed by a higher patency rate.

Topics: Abciximab; Aged; Amputation, Surgical; Angioplasty, Balloon; Antibodies, Monoclonal; Cardiovascular Agents; Drug-Eluting Stents; Feasibility Studies; Female; Humans; Immunoglobulin Fab Fragments; Leg Ulcer; Limb Salvage; Lower Extremity; Male; Metals; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Prospective Studies; Prosthesis Design; Radiography; Recurrence; Sirolimus; Stents; Time Factors; Treatment Outcome; Vascular Patency

Allogeneic bone marrow transplantation or peripheral blood stem cell transplantation (PBSCT) are the only curative therapies for patients with sickle cell disease (SCD). Once the patients have successfully undergone transplantation and engrafted, the hallmark of hemolytic anemia resolves, and normal hemoglobin levels are achieved. Some transplant protocols exclude patients with open wounds, including leg ulcers, because of infection risks associated with transplantation and long-term immunosuppression required to prevent graft-versus-host disease. Recalcitrant and recurrent leg ulcers are a serious complication of SCD and a determinant of morbidity. Here, we report the case of a 37-year-old man with sickle cell anemia and a chronic leg ulcer, who underwent PBSCT, engrafted successfully, and then had complete healing of his ulcer 16 months posttransplant.

Topics: Adult; Anemia, Sickle Cell; Antibiotic Prophylaxis; Humans; Immunosuppressive Agents; Leg Ulcer; Male; Peripheral Blood Stem Cell Transplantation; Risk Adjustment; Sirolimus; Treatment Outcome; Wound Healing; Wound Infection

Topics: Aged; Female; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Leg Ulcer; Sirolimus; Transplant Recipients