[Hemodilution in peripheral arterial occlusive disease. Placebo controlled randomized double-blind study with...

Hemodilution is often recommended for peripheral arterial occlusive disease, yet the ultimate proof of efficacy is lacking in two randomized, placebo-controlled, double-blind, crossover trials (one using Dextran 40 and the other 10% hydroxyethyl starch 200) it has been shown to clinically benefit claudicants. During the hemodilution phases of these trials, where a 500 ml volume was exchanged against 500 ml blood, there was a significant prolongation of the walking distances. With sham-hemodilution there were no beneficial effects. These studies suggest furthermore that responders and non-responders to hemodilution can be identified prior to therapy by angiogram. A theory is developed which implies that low shear forces in vivo are a precondition for the clinical effectiveness of hemodilution. The experimental evidence supporting this theory is reported. Dextran and hydroxyethyl starch do not seem to differ with respect to their clinical response. It is concluded that hemodilution is effective for peripheral arterial occlusive disease stage II and probably even more effective in more advanced stages.