Rheopheresis in patients with ischemic diabetic foot syndrome: results of an open label prospective pilot trial.
Rheopheresis is a specific application of membrane differential filtration, synonymous with double filtration plasmapheresis, for extracorporeal hemorheotherapy. Safety and efficacy of Rheopheresis for wound healing and skin oxygenation were investigated in patients with ischemic diabetic foot syndrome. Eight patients with type 2 diabetes mellitus and non-healing foot ulcers caused by severe ischemic diabetic foot syndrome were treated by a series of seven Rheopheresis sessions in a time span of 11 weeks. Wound healing had not been detectable under conditions of standardized wound care during at least 2 months. Wound status was classified by its morphology, severity and location, according to the criteria of Wagner. Transcutaneous oxygen pressure (tcPO2), laser Doppler flowmetry and vital capillary microscopy were repeatedly performed to monitor the effects of the Rheopheresis treatment series on microcirculation and skin blood flow. Laboratory parameters of blood rheology, endothelial function and inflammatory state were measured in addition to safety parameters. In four patients (baseline Wagner stage 2), Rheopheresis accelerated wound healing of foot ulcers and was associated with an improvement of Wagner stage and a pronounced increase in tcPO2. In two patients (baseline Wagner stage 2), wound healing was unchanged but mean tcPO2 increased, allowing successful minor amputation. Values of tcPO2 remained stable and enhanced for the 3 months follow-up period. In two patients (baseline Wagner stage 4 or 5), no improvements in foot lesions were observed within the treatment period. As an adjunct therapeutic option, Rheopheresis may preserve a functional lower extremity, delay amputation or reduce the extent of amputation.
Klingel
Reinhard
R
Apheresis Research Institute, Cologne, Germany. afi@apheresis-research.de
Mumme
Christian
C
Fassbender
Thurid
T
Himmelsbach
Frido
F
Altes
Ulrich
U
Lotz
Johannes
J
Pohlmann
Thomas
T
Beyer
Jürgen
J
Küstner
Ernst
E
D000368:Aged; D017719:Diabetic Foot / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000098:blood supply*; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010956:Plasmapheresis / Q000379:methods*; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014654:Vascular Patency; D014945:Wound Healing / Q000502:physiology