Normovolemic hemodilution in peripheral arterial disease

Area of Science:

• Vascular Surgery
• Hematology

Background:

• Arterial occlusive disease (Fontaine stage IV) presents significant challenges, particularly with peripheral ulcers.
• Effective therapeutic strategies for advanced occlusive disease remain critical.

Purpose of the Study:

• To evaluate the efficacy of normovolemic hemodilution in patients with severe arterial occlusive disease and peripheral ulcers.
• To explore the rheological and hemodynamic effects of hemodilution as a therapeutic intervention.

Main Methods:

• Normovolemic hemodilution was performed on 25 patients (average age 43) with Fontaine stage IV arterial occlusive disease.
• Procedure involved blood withdrawal, autologous plasma reinfusion, and low-molecular-weight dextran infusion to maintain volemia.
• Patients presented with ulcers on lower limbs, upper limbs, or both.

Main Results:

• A good to very good clinical effect was observed in all patients with upper limb ulcers.
• Healing of lower limb ulcers (feet and toes) showed a less pronounced tendency.
• The degree of lower limb ulcer healing correlated with the number of vascular impediments.

Conclusions:

• Normovolemic hemodilution demonstrates significant therapeutic potential for upper limb ulcers in severe arterial occlusive disease.
• The effectiveness of hemodilution for lower limb ulcers is influenced by the complexity of vascular obstructions.
• Preliminary criteria for indicating hemodilution therapy are discussed based on rheological and hemodynamic principles.