title: Lipid-apheresis improves microcirculation of the upper limbs.
abstract: Lipid-apheresis (LA) is thought to improve microcirculation. However, limited data are available on the effects on peripheral microcirculation. We investigated upper limb microcirculation of 22 patients undergoing regular LA on a weekly basis before and after LA. Using standardized semiquantitative scales, we analyzed blood flow, vasomotor function, and erythrocyte aggregation by capillary microscopy. In addition, capillary blood flow in quiescence and under heat and cryo-stress was evaluated by photoplethysmographic and laser Doppler anemometry. Moreover, levels of vasoactive mediators adrenalin, noradrenalin, endothelin-1 (ET-1), atrial natriuretic peptide (ANP), asymmetrical dimethyl-arginine (ADMA), as well as total protein and fibrinogen were measured. We found a significant increase in blood flow, the number of perfused capillaries and an improvement of erythrocyte aggregation by capillary microscopy. Using laser Doppler anemometry, we were able to show that this increase was predominantly located in the superficial layer capillaries (Δ44.53 ± 135.81%, n.s.) and less so in deeper layer arterioles (Δ2.75 ± 24.84%, n.s.). Vascular response to heat and cryo stress was also improved after LA but failed to reach significance. LA significantly reduced levels of epinephrin (-33 ± 39.2%), ANP (-28.8 ± 20.2%), ADMA (-74.1 ± 23%), and fibrinogen (-45.4 ± 19.7%) when comparing before LA and after LA values. In summary, we found an improvement in the microcirculation of the upper limbs under LA, which may result from a decrease of vasoconstrictors, improvement of vasomotor function, and a decrease in blood viscosity or erythrocyte aggregation.
authors.affiliation: Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Robert-Koch-Strasse 40, Göttingen, Germany.
authors.forename: Jannik
authors.initials: J
authors.lastname: Rossenbach
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Mueller
authors.forename: Katharina
authors.initials: K
authors.lastname: Lange
authors.forename: Victor W
authors.initials: VW
authors.lastname: Armstrong
authors.forename: Jan D
authors.initials: JD
authors.lastname: Schmitto
authors.forename: Erik
authors.initials: E
authors.lastname: Hintze
authors.forename: Jürgen
authors.initials: J
authors.lastname: Helfmann
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Koziolek
mesh_terms: D000328:Adult; D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives / Q000097:blood; D009320:Atrial Natriuretic Factor / Q000097:blood; D001781:Blood Component Removal / Q000379:methods*; D001783:Blood Flow Velocity; D019332:Endothelin-1 / Q000097:blood; D004837:Epinephrine / Q000097:blood; D004903:Erythrocyte Aggregation; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006225:Hand; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D017078:Laser-Doppler Flowmetry; D008055:Lipids / Q000097:blood* / Q000302:isolation & purification*; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D020678:Microscopic Angioscopy; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D017156:Photoplethysmography
chemical_list: D019332:Endothelin-1; D008055:Lipids; C018524:N,N-dimethylarginine; D009320:Atrial Natriuretic Factor; D005340:Fibrinogen; D001120:Arginine; D009638:Norepinephrine; D004837:Epinephrine