INCREASE IN LEG BLOOD-FLOW BY NORMOVOLqMIC HqMODDLUTION IN INTERMITTENT CLAUDICATION

Yates, Christopher J; Andrews, Vivienne; Berent, Anna; Dormandy, J.A.

doi:10.1016/s0140-6736(79)91433-8

Cited by 85 publications

(17 citation statements)

References 5 publications

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“…This minimal hemodilution is not sufficient to explain the improvement in the clinical picture. Studies describing improvements in WD as a result of hemodilution reported hematocrit values of 35%, with blood dilutions of 21.5% [29] , so obviously higher than those we found after fibrinogen apheresis.…”

Section: Discussioncontrasting

confidence: 76%

Fibrinogen Apheresis in the Treatment of Peripheral Arterial Disease

Ramunni¹,

Brescia²,

Quaranta³

et al. 2007

Blood Purif

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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. Aim: 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.

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Section: Discussioncontrasting

confidence: 76%

Fibrinogen Apheresis in the Treatment of Peripheral Arterial Disease

Ramunni¹,

Brescia²,

Quaranta³

et al. 2007

Blood Purif

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“…Dextran-40, a polysaccharide plasma volume expander, has been used for hemodilution, for treatment of chronic limb ischemia [27][28][29]. Decreasing viscosity and rouleaux formation prevent slugging of small vessels and capillaries.…”

Section: Discussionmentioning

confidence: 99%

“…Although this study encompassed a small cohort of 20 patients, none of the patients developed recurrence during follow-up of 1-5 years (mean 3. A few authors have described improvement in microcirculation after treatment of CLI, as measured by DSA [17], Doppler [27,28], plethysmography [29], thallium scintigraphy, or RBC scan. In this preliminary study, CTA, a noninvasive imaging tool, has been used for assessment of vascular changes, with efficacy for vascular imaging, similar to DSA.…”

Section: Discussionmentioning

confidence: 99%

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Improvement in Blood Supply After “Heparin-Dextran” Therapy in Patients of Buerger’s Disease with Critical Limb Ischemia

et al. 2012

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Alleviating the agonizing pain of critical limb ischemia (CLI) in patients of Buerger's disease (BD) has been challenging, due to lack of definitive treatment; "Heparin-Dextran" infusion has been tried in this study. Assessment of clinical improvement and vascular changes following therapy. Patients with CLI admitted to emergency surgical ward were studied prospectively. BD was diagnosed by Shionoya's criteria, and confirmed by digital subtraction angiography (DSA). Heparin and Dextran intravenous infusion was administered for 10 days. Severity of rest pain, ischemic changes in the feet, claudication distance and ankle brachial index (ABI) were estimated prior to therapy, at completion and 3 weeks after therapy. Vascular changes were assessed by CT angiography (CTA) performed prior to and 3 weeks after therapy. Twenty consecutive patients were studied. Successful hemodilution reflected by decreased hematocrit (37.4 % to 32.6 %, p<0.05) and increased mean ABI (0.46 to 0.83, p<0.01), improved rest pain in 75 % patients (p<0.001), increased claudication distance in 94 % (p<0.05) and ulcers healing in 70 % patients. CTA revealed recanalised vessels (decreased length of occluded segments) in 10 (50 %, p00.005), increased collaterals in 12 (60 %, p<0.01) and improved distal run-off in 13 (65 %, p<0.01) patients. "Heparin-Dextran" therapy in patients of CLI from BD improves tissue perfusion by increasing collaterals and recanalisation of vessels, resulting in significant relief from rest pain and clinical improvements. CTA is as efficacious as DSA for evaluation of BD.

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“…High haemoglobin levels, even within the normal range, have been recognised as a risk factor in various ischaemic diseases [1,4,12,18], and there are several reports suggesting that haemodilution is a successful thera peutic approach in such cases [6,8,19], The probable explanation of these findings is that an increased haemoglobin concentration causes an exponential increase of blood vis cosity and a consequent slowing of the blood flow. The present investigation was carried out to determine whether the preoperative haemoglobin concentration was a significant factor in the early complications following reconstructive arterial surgery.…”

Section: Introductionmentioning

confidence: 99%

Importance of the Preoperative Haemoglobin Concentration in Arterial Surgery

Mátrai¹,

Kollár²

1987

Eur Surg Res

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A study of reconstructive operations for ischaemia of the legs showed a correlation between a high preoperative haemoglobin level and early postoperative reocclusion. The mean preoperative haemoglobin level of patients with early reocclusion (165 ± 3 g/l, SEM) was significantly higher (p < 0.001) than that of patients who did not reocclude (153 ± 3 g/l). There was no significant difference in the total serum protein concentrations, suggesting that dehydration was not the cause of the difference observed in haemoglobin concentration. The mechanism may be the lower flow rate associated with the higher haemoglobin content and increased blood viscosity.

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INCREASE IN LEG BLOOD-FLOW BY NORMOVOLqMIC HqMODDLUTION IN INTERMITTENT CLAUDICATION

Cited by 85 publications

References 5 publications

Fibrinogen Apheresis in the Treatment of Peripheral Arterial Disease

Fibrinogen Apheresis in the Treatment of Peripheral Arterial Disease

Improvement in Blood Supply After “Heparin-Dextran” Therapy in Patients of Buerger’s Disease with Critical Limb Ischemia

Importance of the Preoperative Haemoglobin Concentration in Arterial Surgery

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