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Heparin-Mediated Extracorporeal Low-Density Lipoprotein Precipitation Apheresis for Treating Peripheral Arterial
Stefania Rotella1, Loreto Gesualdo1, Marco Fiorentino1
1Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRE-J), University of Bari Aldo Moro, 70121 Bari, Italy.
Insights
Heparin-mediated extracorporeal low-density lipoprotein precipitation (H.E.L.P.) apheresis improved peripheral arterial disease (PAD) symptoms in an end-stage renal disease (ESRD) patient. This treatment offers a potential option for patients unresponsive to standard therapies.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Vascular Surgery
Background:
- Patients with chronic kidney disease (CKD), especially end-stage renal disease (ESRD), exhibit high rates of cardiovascular disease (CVD) and peripheral arterial disease (PAD).
- Standard medical management focuses on risk factor control, while surgery is the primary intervention for specific conditions.
- Heparin-mediated extracorporeal low-density lipoprotein precipitation (H.E.L.P.) apheresis effectively reduces lipoproteins, fibrinogen, and inflammatory markers, mitigating cardiovascular risk.
Purpose of the Study:
- To evaluate the efficacy of H.E.L.P. apheresis in an ESRD patient with severe PAD who had not responded to revascularization and was unsuitable for further surgery.
- To assess the impact of H.E.L.P. apheresis on clinical condition, foot lesions, and walking distance in this patient population.
Main Methods:
- A treatment protocol involving H.E.L.P. apheresis was administered to an ESRD patient with severe PAD.
- The protocol included an intensive initial phase of weekly treatments, followed by sessions every 10-15 days for six months.
- Clinical outcomes, including foot lesions and walking capacity, were monitored.
Main Results:
- The patient showed significant improvement in overall clinical condition, foot lesions, and walking distance within two months of treatment.
- The H.E.L.P. apheresis protocol successfully prevented the need for foot amputation.
- The study highlights the potential of LDL apheresis in improving microcirculation and clinical outcomes.
Conclusions:
- H.E.L.P. apheresis demonstrated significant clinical benefits in an ESRD patient with severe PAD, even with normal LDL cholesterol and lipoprotein (a).
- This therapeutic approach may be a valuable option for patients with severe PAD who are refractory to conventional treatments.
- Further investigation into the broader application of LDL apheresis for similar patient profiles is warranted.
Abstract:
Patients with chronic kidney disease (CKD), particularly those with end-stage renal disease (ESRD), have a high prevalence of cardiovascular disease and peripheral arterial disease (PAD). Medical treatment is mainly based on risk factor management, and the surgical approach remains the gold standard treatment in specific conditions. Heparin-mediated extracorporeal low-density lipoprotein precipitation (H.E.L.P.) apheresis is effective in reducing circulating lipoprotein, fibrinogen, inflammatory mediators and procoagulant factors, thereby reducing cardiovascular risk in patients with familial hypercholesterolemia and hypertriglyceridemia. These activities may be effective in reducing symptoms and ischemic vascular lesions even in patients with severe PAD. We reported the application of a treatment protocol with H.E.L.P. apheresis in an ESRD patient with severe PAD without clinical improvement after severe revascularization who was not suitable for further surgical approaches, despite normal LDL cholesterol and lipoprotein (a). The H.E.L.P. protocol was characterized by an intensive first phase with weekly treatments followed by a single session every 10-15 days for 6 months of treatment. The overall clinical condition, foot lesions and walking distance improved significantly after the first 2 months of treatment, and foot amputation was avoided. Here, we review the main pathogenetic mechanisms through which LDL apheresis improves microcirculation and clinical outcomes. Its wider application may represent an optimal therapeutic option for patients unresponsive to standard treatment.
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