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Treatment of arteriosclerotic obstruction by LDL adsorption
T Agishi1, S Naganuma, S Nakasato
1Kidney Center, Tokyo Women's Medical College, Japan.
Insights
LDL adsorption effectively treats arteriosclerotic obstruction (ASO) in lower extremities. This safe extracorporeal technique improves symptoms and objective findings in dyslipidemic patients with ASO.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Nephrology
Background:
- Arteriosclerotic obstruction (ASO) of lower extremities frequently co-occurs with dyslipidemia.
- Dyslipidemia, characterized by elevated cholesterol levels, is a significant risk factor for ASO progression.
- Current treatments for ASO may not adequately address underlying lipid abnormalities.
Purpose of the Study:
- To evaluate the efficacy and safety of LDL adsorption in treating patients with symptomatic lower extremity ASO and dyslipidemia.
- To assess the impact of LDL apheresis on subjective symptoms and objective clinical findings in ASO patients.
Main Methods:
- A series of 10 LDL adsorption procedures using a dextran sulfate/cellulose adsorbent column was performed.
- Extracorporeal circulation technique was employed for LDL removal.
- Patient outcomes were assessed through subjective symptom reporting and objective measurements like plethysmography, thermography, and ankle pressure index.
Main Results:
- Significant improvements were observed in subjective symptoms, including coldness (88.5%), intermittent claudication (87.1%), rest pain (53.8%), and ulcer/necrosis (60%).
- Objective findings corroborated subjective improvements, with enhancements in plethysmography (85.7%), thermography (81%), and ankle pressure index (70%).
- No serious complications or adverse effects were reported during or after the LDL adsorption procedures.
Conclusions:
- LDL adsorption is a safe and effective therapeutic option for managing dyslipidemic patients with arteriosclerotic obstruction in the lower extremities.
- This apheresis technique offers a promising approach to improve both clinical symptoms and objective markers in ASO.
- The study supports the use of LDL adsorption as an adjunct therapy for ASO, particularly in patients with significant lipid abnormalities.
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.