Clinical Trial of Low Density Lipoprotein-Apheresis for Treatment of Diabetic Gangrene.

Abstract

A 68-year-old man with a 28-year history ofnon-insulin dependent diabetes mellitus (NIDDM) was admitted to our hospital because of foot gangrene. He had previously suffered from cerebral infarction resulting in right hemiplegia and his right foot was amputated because of right femoral lesion presenting diabetic foot gangrene 5 years previously. The diabetic foot gangrene gradually becameworse, although he had received various medications. Then, we attempted to treat the patient with low density lipoprotein (LDL)-apheresis ten times a month. The foot gangrene itself and the local circulation around the gangrene lesion were remarkably improved after treatment with LDL-apheresis. Wepresent here the first case of diabetic foot gangrene improved by LDLapheresis. LDL-apheresis therapy is anticipated to be a newtherapeutic approach for treatment of fatal foot gangrene associated with diabetes mellitus. (Internal Medicine 36: 898-902, 1997)

The wound/burn guidelines – 3: Guidelines for the diagnosis and treatment for diabetic ulcer/gangrene

“…Comments: Concerning the effects of LDL apheresis on diabetic ulcers, there are two case series studies and four case reports, and the evidence level is V. LDL apheresis as a treatment for ASO of the leg is covered by health insurance in Japan and has been reported to be effective. However, it is not mentioned as a treatment for diabetic or non‐diabetic PAD in the TASCII, which is an international guideline for the diagnosis and treatment of ASO of the leg.…”

“…However, it is not mentioned as a treatment for diabetic or non‐diabetic PAD in the TASCII, which is an international guideline for the diagnosis and treatment of ASO of the leg. Concerning its effectiveness in clinical situations, there are only sporadic case series studies and case reports The principle of this treatment is to adsorb and eliminate lipoproteins such as LDL and very low‐density lipoprotein, which are arteriosclerogenic factors, using dextran sulfate given a strong negative electrical charge as an adsorption ligand.…”

Selective Hemapheresis, an Effective New Approach in the Therapeutic Management of Disorders Associated with Rheological Impairment: Mode of Action and Possible Clinical Indications

“…This so‐called diabetic foot is mostly characterized by highly elevated fibrinogen plasma levels that complicate wound healing and, therefore, maintain superinfections and make it difficult to stabilize the blood‐glucose levels. Although until now only anecdotal case reports have been communicated in the literature, this circulus vitiosus might be overcome by an effective fibrinogen lowering, either by conventional means such as ancrod or urokinase treatment or by extracorporeal fibrinogen elimination using HELP, cascade filtration, or the new fibrinogen adsorber technology (29,30).…”