Fibrinogen Apheresis in the Treatment of Peripheral Arterial Disease

Abstract

Background: Fibrinogen is mainly responsible for determining the viscosity of whole blood. In peripheral arterial disease (PAD) the fibrinogen concentration seems to affect the microcirculation flow. Aim: To study the effects of an abrupt reduction of fibrinogen on the hemodynamics of the lower extremities and the clinical picture of patients with PAD. Methods: Ten patients affected by various stages of PAD underwent 1 session of fibrinogen apheresis (TheraSorb, Miltenyi Biotec, Germany). Laboratory parameters of endothelial activation were assessed before and after the session, as well as walking distance (WD), the ankle-brachial index and laser Doppler flowmetry. Results: A significant reduction in the laboratory parameters was observed: fibrinogen (50%), total cholesterol (18%), LDL cholesterol (24%), sE-selectin (23%), sICAM-1 (19%) and sVCAM-1 (10%). The procoagulant factors, factor VIII and von Willebrand factor, did not vary significantly. Both pain-free and total WD were significantly improved (p < 0.003 and p <0.006, respectively), the ankle-brachial index remained unchanged, and laser Doppler flowmetry showed a modest but not significant increase. Conclusions: Fibrinogen apheresis allowed us to study the effects of an acute modification of fibrinogen in PAD, on both some aspects of the endothelial function and on the hemodynamics, demonstrating an improvement of WD and a minimal increase in the skin microcirculation.

Double Filtration Plasmapheresis in Different Diseases in Thailand

“…Referring to previous reports, DFPP decreased the adhesive molecules and oxidative stresses and improved trancutaneous tissue oxygenation and flow along the length of the limb artery (14,15,25). Two cases of diabetes nephropathy showed stable renal function during the last 2 years, and one case of diabetes with PAD on dialysis showed better tissue oxygenation and no deterioration of foot blood supply (19,20,28–31). DFPP in diabetes is very new, and was proposed first in this report.…”

“…This phenomenon happens in many diseases that are well documented such as coronary heart diseases and familial hyperlipidemia (12,13,16,17). It also has been proposed as a benefit in some diseases that are rarely or partly referenced such as peripheral arterial diseases, diabetes nephropathy, macular degeneration, and sensorineural hearing loss (26–32). The diabetes cases reported herein had renal impairment.…”

“…DFPP in diabetes is very new, and was proposed first in this report. As a matter of fact, removing hyperviscosity, or atherosclerotic factors (32) should be worthwhile for all impaired microcirculation (31), and should be a standard for PAD treatment, not just waiting for bypass surgery.…”

Therapeutic apheresis in peripheral and retinal circulatory disorders

“…Taking into account another microcirculation disorder, peripheral arterial disease (PAD), a single session of fibrinogen apheresis was shown to be able to improve the clinical picture with a significant increase in both total and pain-free walking distance, as a result of drastic reduction in serum fibrinogen concentration [9]. …”

Selective Fibrinogen Apheresis for Improvement in Microvascular Hemodynamics

“…In this issue of Blood Purification , Ramunni's group [1] reports on the short-term effects of fibrinogen apheresis in patients with peripheral arterial disease. Their study was designed to elucidate the immediate post-treatment effect of an abrupt reduction in fibrinogen on the hemodynamics of the lower extremities.…”