Peripheral arterial disease is more aggressive in concomitant diabetes posing an increased
risk for critical limb ischemia and subsequent limb loss. The majority of therapies
available are not effective to prevent amputation in patients with severe disease.
The current observational study reports the effect of the heparin-induced extracorporal
LDL-precipitation (H.E.L.P.) as a novel therapeutic approach in patients with severe
diabetic foot syndrome. Seventeen diabetic patients with septic foot lesions recruited
from the diabetic outpatient clinic underwent H.E.L.P. apheresis regularly until fibrinogen
levels were stabilized at 3 g/l or infection was controllable as evidenced by alleviation
of necrosis. Patients were subsequently followed up for 2 to 73 months. Fibrinogen
levels were reduced by 68% after H.E.L.P. treatment. No severe complications were
noted. Necrosis could be confined in sixteen patients. Minor amputations were indicated
in twelve patients. Three patients underwent major amputations of the lower limb and
two patients received surgical reconstruction. In conclusion, H.E.L.P. apheresis may
offer an alternative therapeutic option to diabetic patients with critically ischemic
feet and appears to have a beneficial major/minor amputation ratio.
amputation - diabetic foot ulcers - fibrinogen - heparin-induced extracorporal lipid
apheresis - peripheral arterial disease
