Treatment of Arteriosclerotic Obstruction by LDL Adsorption

Abstract

According to the authors' clinical analysis, about half of the patients who suffer from arteriosclerotic obstruction (ASO) in the lower extremity(-ies) with clinical manifestation are dyslipidemic (total cholesterol > or = 220 mg/dL or LDL cholesterol > or = 140 mg/dL). As suggested by clinical success in regression of ASO in the coronary arteries as a result of aggressive removal of LDL, LDL adsorption utilizing an extracorporeal circulation technique with a dextran sulfate/cellulose adsorbent column was applied in 33 patients (22 men and 11 women) with ASO. Clinical results obtained after a series of 10 LDL adsorption procedures as a standard showed encouraging success. Improvement in subjective symptoms was achieved as follows: 88.5% for cold lower extremity, 87.1% for intermittent claudication, 53.8% for leg/toe pain at rest, and 60% for disappearance/size diminution of ulcer/necrosis. Improvements in objective examination findings supported subjective ones: 85.7% by plethysmography, 81% by thermography and 70% by ankle pressure index. No serious complications or untoward effects were observed during or after the adsorption procedures. In conclusion, LDL adsorption appears to be a useful and safe tool in treatment of ASO patients with dyslipidemia.

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

“…Multiple mechanisms appear to be involved in the rapid response. A drastic reduction in LDL cholesterol reduces blood viscosity [35] and improves erythrocytic deformability [36] . Moreover, the removal of clotting factors, namely factor VIII and von Willebrand factor, helps improve the hemorheological picture [5,6,37] .…”

LDL-apheresis improves peripheral arterial occlusive disease with an implication for anti-inflammatory effects

“…In parallel with this evidence, there is a finding that blood flow to the lower limbs is enhanced by plasma exchange [5]. Based on these findings, LDLapheresis has been also applied for the treatment of PAOD [6,7]. LDL-apheresis is also known to retard the progression of coronary atherosclerosis as shown by a prospective, open, randomized study (the LDLApheresis Atherosclerotic Regression Study: LAARS) [8].…”

LDL-cholesterol lowering and atherosclerosis - clinical benefit and possible mechanisms: an update

“…LDL-apheresis has been shown to change peripheral and cerebral haemodynamics favourably by short term improvements in the rheological properties of whole blood and probably also by restoring endothe lium-dependent vasodilation [74,75]. The application of this method may offer opportunities in the preven tion of progression of atherosclerosis as has been shown in selected patients with a primary hyperlipidaemia and established CAD or PVD refractory to drug treatment [24,37,38,[76][77][78][79][80][81].…”

“…Most of these tiñáis have shown slowing or arrest of progression of coronary atherosclerosis. Reports concerning femoral atherosclerosis are more scarce [7,[14][15][16]21,24,25], In several recent clinical trials on plasma lipid regu lation, measurements of carotid artery intima-media thickness (IMT) have been included, because coro nary and carotid atherosclerosis share coronary events as their major cause of morbidity and mortality [38][39][40][41]. Indeed, most of these studies have also shown a slowing of progression of IMT during lipid-lowering treatment.…”