By Thomas S. May
HELSINKI, FINLAND -- June 11, 2007 -- The selective removal of fibrinogen from the blood by a method called fibrinogen apheresis helps improve the symptoms of peripheral artery disease, as well as some laboratory parameters implicated in endothelial damage, according to a study presented here at the 76th congress of the European Atherosclerosis Society (EAS).
"The aim of our study was to assess the short term impact of a sudden reduction in fibrinogen on the circulation at the lower extremities and on some aspects of endothelial function in patients affected by peripheral arterial disease (PAD)," said lead researcher Alfonso Ramunni, MD, Division of Nephrology, Department of Internal and Public Medicine, University Of Bari, Bari, Italy. "The availability of selective apheresis procedures does not only offer therapeutic opportunities but also enables scientific investigation to gain a better understanding of the pathogenetic mechanisms underlying atherosclerosis," he added.
Dr. Ramunni and colleagues utilized special fibrinogen apheresis equipment to eliminate fibrinogen from the plasma of seven male patients (mean age 73±10 years), affected by PAD, in two sessions at weekly intervals. The researchers measured total cholesterol (TC), LDL cholesterol (LDL), fibrinogen (FB), and some markers of endothelial activation before and after each session. Walking distance (WD), ankle-brachial index (ABI) and laser doppler (LD) of the extremities were also evaluated before and after each session.
The investigators found that, besides an improvement in the symptoms of PAD, there was also a reduction in some laboratory parameters implicated in endothelial damage, as well as a modest improvement in microcirculation. Mean pre- and post-apheretic values of some of the lab parameters were as follows: TC 195±26 vs. 162±23; LDL 119±25 vs. 90±20¸ FB 336±86 vs. 165±39 mg/dl (P <.0001 for all three parameters). Moreover, total WD increased from 79±60 to 194±80 meters (P =.006), and pain-free WD improved from 60±52 meters to 173±76 meters (P =.003).
Although these results are encouraging, it is still to be seen whether it is best to perform fibrinogen apheresis in the earlier stages of the disease, and what the best treatment schedule is, Dr. Ramunni cautioned. "In any case, there can be no doubt that this new method warrants a larger study to investigate its effects on endothelial function," he concluded.
[Presentation title: Fibrinogen Apheresis (FA) in the Treatment of Peripheral Artery Disease (PAD). Abstract P329]
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