Lipoprotein apheresis in patients with peripheral artery disease and hyperlipoproteinemia(a).
OBJECTIVE
Hyperlipoproteinemia(a) [Lp(a)-HLP] is a major risk factor for severe atherosclerosis. The present investigation sought to assess the effect of lipoprotein apheresis (LA) in patients with peripheral artery disease (PAD) and Lp(a)-HLP.


METHODS
In January 2013, we started a registry for Lp(a)-HLP patients who receive weekly LA in our center. So far, ten patients with severe PAD and isolated Lp(a)-HLP who recently underwent revascularization (index procedure) have been included. Pain level, ankle-brachial-index (ABI), transcutaneous oxygen pressure (tcpO2) and walking distance were determined before, as well as 1, 3, 6 and 12 months after initiation of LA. Furthermore, the mean time interval between revascularizations within the 12 months prior to the index procedure and up to 12 months after the index procedure was assessed.


RESULTS
All analyzed parameters significantly improved under LA. When comparing the results before LA with the results after 12 months, the ankle-brachial-index increased from 0.5 ± 0.2 to 0.9 ± 0.1 (P < 0.001). The tcpO2 levels also increased from 42.9 ± 2.3 mmHg to 59.0 ± 8.9 mmHg (P < 0.001). The improved microcirculation was associated with a reduction of the mean pain level from 7.0 ± 1.5 to 2.0 ± 0.8 (P < 0.001) as determined using the visual analog scale. The walking distance increased from 87 ± 60 m to 313 ± 145 m (P < 0.001). Importantly, the frequency of revascularization procedures was strongly decreased under LA. All patients combined underwent 35 revascularizations within the 12 months prior to the index procedure (mean interval between two revascularizations: 104.3 days). Since the index procedure, only one revascularization was necessary within 79 patient-months under LA (mean interval: 2404.5 days, P < 0.001).


CONCLUSIONS
LA improves circulation, oxygen supply, level of pain and walking distance in patients with severe PAD and Lp(a)-HLP. The frequency of revascularization procedures is strongly reduced under LA treatment.
Klinik für Kardiologie und Angiologie, Campus Mitte, Charité - Universitätsmedizin Berlin, Germany.
Wolfram C
WC
Poller
Klinik für Kardiologie und Angiologie, Campus Mitte, Charité - Universitätsmedizin Berlin, Germany.
Henryk
H
Dreger
Schwerpunktpraxis für Nieren- und Hochdruckkrankheiten Berlin, Germany.
Stanislao
S
Morgera
HELIOS Klinikum Emil von Behring, Klinik für Gefäßmedizin, Berlin, Germany.
Axel
A
Berger
HELIOS Klinikum Emil von Behring, Klinik für Gefäßmedizin, Berlin, Germany.
Ingo
I
Flessenkämper
HELIOS Klinikum Emil von Behring, Klinik für Gefäßmedizin, Berlin, Germany. Electronic address: kathrin.enke-melzer@helios-kliniken.de.
Kathrin
K
Enke-Melzer
D055109:Ankle Brachial Index; D015415:Biomarkers / Q000097:blood; D001781:Blood Component Removal / Q000379:methods*; D001785:Blood Gas Monitoring, Transcutaneous; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005858:Germany; D006439:Hemodynamics; D006801:Humans; D006951:Hyperlipoproteinemias / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010147:Pain Measurement; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D017270:Lipoprotein(a)
Hyperlipoproteinemia(a); Lipoprotein apheresis; Lipoprotein(a); Peripheral artery disease