First Experiences with the Heparin-lnduced Extracorporeal Low-Density Lipoprotein Precipitation in the Treatment of Critical Limb Ischaemia: A New Therapeutical Approach?

Walzl, Manfred; Lechner, P.; Walzl, B.; Lechner, H; Cesnik, H

doi:10.1159/000216881

Cited by 7 publications

(13 citation statements)

References 11 publications

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“…2). It is possible that the improvement in rCBF can be related (as has been suggested for increased blood flow to the lower limbs in PAD [6,9,10]) to an effec tive reduction of fibrinogen as well as of lipo proteins, both influencing whole blood and plasma viscosity. In cases of hyperlipidemia, the RCTT, a measure related to the concen tration of lipoproteins [20], was improved.…”

Section: Discussionmentioning

confidence: 99%

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Increased Cerebral Perfusion following Reduction of Fibrinogen and Lipid Fractions

Walzl

Walzl²,

Valetitsch³

et al. 1995

Pathophysiol Haemos Thromb

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High levels of plasma fibrinogen in cerebrovascular disease cause deterioration in the hemorheologic pattern, microcirculation and cerebral perfusion. We compared the value of hepa-rin-induced extracorporeal LDL precipitation (HELP) which is a method that safely and effectively reduces plasma fibrinogen and lipoproteins and so improves the hemorheologic pattern and blood flow properties. Regional cerebral blood flow (rCBF) was measured by the ¹³³Xe SPECT clearance method. After first measuring rCBF, 15 patients suffering from cerebral multi-infarct disease underwent a single HELP application. One hour later a second measurement of rCBF was performed. Fifteen other patients with similar clinical symptoms and findings on CAT scans who were not subjected to HELP served as controls. The HELP treatment produced an immediate and statistically significant reduction of all parameters relevant to hemorheology, such as plasma fibrinogen, whole blood viscosity at both high and low shear rate, plasma viscosity, and red cell transit time. Total cholesterol, low density lipo-protein, and triglycerides were also reduced. The treated group showed 9.7-19.9% increased rCBF in different vascular regions examined relative to the untreated controls. The results obtained indicate that HELP has a potent effect in a situation demanding rapid and significant improvement of the blood flow.

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Section: Discussionmentioning

confidence: 99%

“…Recently it has been shown that HELP even in patients with PAD can lead to an improvement of clinical symptoms. This elimination of substances negatively in fluencing hemorheology was followed by an increase of blood flow and microcirculation in the lower limbs [6,9,10].…”

Section: Introductionmentioning

confidence: 99%

Increased Cerebral Perfusion following Reduction of Fibrinogen and Lipid Fractions

Walzl

Walzl²,

Valetitsch³

et al. 1995

Pathophysiol Haemos Thromb

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“…2,8,9 Additionally, fibrinogen levels increase after an acute infarction, affecting the hemorrheologic pattern, such as whole blood and plasma viscosity as well as deformability and aggregability of red blood cells, causing a reduction in microcirculatory floW.2,6,8-10 A major goal in the management of infarctions and/or chronic occlusions should therefore include normalization of hyperfibrinogenemia.11,12 Several agents to improve hemorrheology and/or anticoagulant therapy are being studied. 2,8,9 Additionally, fibrinogen levels increase after an acute infarction, affecting the hemorrheologic pattern, such as whole blood and plasma viscosity as well as deformability and aggregability of red blood cells, causing a reduction in microcirculatory floW.2,6,8-10 A major goal in the management of infarctions and/or chronic occlusions should therefore include normalization of hyperfibrinogenemia.11,12 Several agents to improve hemorrheology and/or anticoagulant therapy are being studied.…”

Section: Introductionmentioning

confidence: 99%

“…6,9,[12][13][14][15][16][17][18][19] Hence, the HELP system is used to improve rheologic properties of blood during acute and/or chronic atherosclerotic events. 6,9,[12][13][14][15][16][17][18][19] Hence, the HELP system is used to improve rheologic properties of blood during acute and/or chronic atherosclerotic events.…”

Section: Introductionmentioning

confidence: 99%

Heparin-Induced Extracorporeal Fibrinogen/LDL Precipitation (HELP): A Promising Regimen for the Treatment of Vascular Diseases

Walzl¹,

Haas²,

Walzl³

1997

Angiology

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Current management of atherosclerotic diseases consists primarily of medical therapy designed to increase oxygen supply to the heart, the brain, retinal vessels, or lower limbs. The development of these diseases is based on atherosclerotic changes induced by risk factors such as elevated levels of fibrinogen and lipoproteins. These risk factors are related to a dramatic deterioration of the hemorrheologic pattern, which reduces perfusion. Consequently, attempts are now being made to treat ischemia via hemorrheological intervention. A new treatment modality utilizing the heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP), offers the possibility of obtaining therapeutic success not only in cases of severe hypercholesterolemia but also in the field of hemorheology. With HELP a safe and rapid reduction of fibrinogen and lipid fractions has become feasible, thus providing acute improvements of red cell aggregation, of the filterability of blood cells, of whole-blood and plasma viscosity, and thereby of microcirculation. Because cerebrovascular diseases are known to be related to disturbances of the hemorrheological situation, the HELP system is used in the Department of Electrobiology of Graz for the treatment of acute stroke, cerebral multi-infarct disease, and occlusions of retinal arteries.

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“…Alternative applications LDL-apheresis alteration of vascular markers and immediate improvement of endothelial function [27•], nitric oxide levels, and microvascular flow has resulted in its use for other forms of acute and chronic vascular diseases resistant to standard medical therapy, such as peripheral vascular disease [28•], cerebral vascular disease [29], end-stage renal disease [30•], cardiac transplantation [31], dilated cardiomyopathy [32], ocular microcirculatory disturbances [33•], and sudden idiopathic hearing loss [34•]. Insurance coverage and LDL-apheresis therapy is almost universally covered by private health insurers, reimbursement for LDL-apheresis Medicare, and other government payers.…”

Section: Contraindications/complications/aesmentioning

confidence: 99%

LDL-apheresis therapy

Moriarty

2006

Curr Treat Options Cardio Med

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Low-density lipoprotein (LDL)-apheresis is an effective means for acutely lowering plasma cholesterol (LDL reduction > 60%) and reducing cardiovascular events in patients with uncontrolled hypercholesterolemia who are genetically predisposed or resistant to standard therapy. Despite its known benefit, apheresis is performed in only a minority of qualified patients. In addition to reducing plasma cholesterol, apheresis can alter other markers of vascular disease (inflammation, rheology, thrombosis, and fibrinolysis). The acute and chronic changes to the vascular system may warrant LDL-apheresis use in other diseases.

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First Experiences with the Heparin-lnduced Extracorporeal Low-Density Lipoprotein Precipitation in the Treatment of Critical Limb Ischaemia: A New Therapeutical Approach?

Cited by 7 publications

References 11 publications

Increased Cerebral Perfusion following Reduction of Fibrinogen and Lipid Fractions

Increased Cerebral Perfusion following Reduction of Fibrinogen and Lipid Fractions

Heparin-Induced Extracorporeal Fibrinogen/LDL Precipitation (HELP): A Promising Regimen for the Treatment of Vascular Diseases

LDL-apheresis therapy

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