Fibrinogen apheresis in the treatment of peripheral arterial disease.
BACKGROUND
Fibrinogen is mainly responsible for determining the viscosity of whole blood. In peripheral arterial disease (PAD) the fibrinogen concentration seems to affect the microcirculation flow.


OBJECTIVE
To study the effects of an abrupt reduction of fibrinogen on the hemodynamics of the lower extremities and the clinical picture of patients with PAD.


METHODS
Ten patients affected by various stages of PAD underwent 1 session of fibrinogen apheresis (TheraSorb, Miltenyi Biotec, Germany). Laboratory parameters of endothelial activation were assessed before and after the session, as well as walking distance (WD), the ankle-brachial index and laser Doppler flowmetry.


RESULTS
A significant reduction in the laboratory parameters was observed: fibrinogen (50%), total cholesterol (18%), LDL cholesterol (24%), sE-selectin (23%), sICAM-1 (19%) and sVCAM-1 (10%). The procoagulant factors, factor VIII and von Willebrand factor, did not vary significantly. Both pain-free and total WD were significantly improved (p < 0.003 and p <0.006, respectively), the ankle-brachial index remained unchanged, and laser Doppler flowmetry showed a modest but not significant increase.


CONCLUSIONS
Fibrinogen apheresis allowed us to study the effects of an acute modification of fibrinogen in PAD, on both some aspects of the endothelial function and on the hemodynamics, demonstrating an improvement of WD and a minimal increase in the skin microcirculation.
Ramunni
A
A
Division of Nephrology, Department of Internal and Public Medicine, University of Bari, Bari, Italy. a.ramunni@nephro.uniba.it
Brescia
P
P
Quaranta
D
D
Plantamura
M
M
Ria
R
R
Coratelli
P
P
D000368:Aged; D000369:Aged, 80 and over; D001781:Blood Component Removal; D004730:Endothelium, Vascular / Q000503:physiopathology; D017079:Exercise Tolerance; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006439:Hemodynamics; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008833:Microcirculation / Q000503:physiopathology; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D012867:Skin / Q000098:blood supply; D016896:Treatment Outcome; D016138:Walking
D005340:Fibrinogen