Journal article
Reduced amputation rate with isovolemic hemodilution in critical limb ischemia patients
Clinical hemorheology and microcirculation, v 67(2)
01 Jan 2017
PMID: 28922142
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
AIMS: Critical limb ischemia (CLI) patients are characterized by intractable pain in spite of medication, non-healing ulcers, and gangrene. The objective of this study was to investigate whether or not isovolemic hemodilution treatment can reduce the rate of major amputations in CLI.
METHODS: 28 patients were studied who had tissue loss on Rutherford Grade III, Category 5 or 6. The subjects were divided into two arms: standard-of-care, conventional therapy (CT) (n = 15) as a control group and hemodilution therapy (HT) (n = 13) as a study group. For the HT group, weekly isovolemic hemodilution was performed over 4 consecutive weeks, removing 250 ml of whole blood with the infusion of hydroxyl-ethyl starch solution. Blood viscosity, hematocrit, hemoglobin, ankle-brachial index, VA pain scale, time-to-amputation from admission, and survival time were measured.
RESULTS: The mean Hct gradually decreased from 36.6 to 35.1, whereas the WBV at a shear rate of 1 s(-1) significantly decreased from 18.2 to 10.5 during the same period. Subsequently, tissue oxygen delivery index, defined as the ratio of Hct to WBV at a shear rate of 1 s(-1), increased from 24.4 to 37.0 by 51.7%, suggesting improvements in oxygen delivery in the patients. The average rate of lower limb major amputation in the control group was 93% (14/15), whereas that in the study group was 31% (4/13) (p = 0.001). Amputation-free median survival time and amputation-free 5-year survival rate in the control group were 1.2 months and 7%, while those in the study group were 30.2 months and 44% (p = 0.001). There were no adverse effects from repetitive hemodilution in the study group.
CONCLUSIONS: Isovolemic hemodilution treatment of CLI patients was found to be well-tolerated and reduced the rate of major amputation resulting from the deterioration of CLI.
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Details
- Title
- Reduced amputation rate with isovolemic hemodilution in critical limb ischemia patients
- Creators
- Doosang Kim - Department of Thoracic and Cardio-Vascular Surgery, Veterans Health Service Medical Center, Seoul, Korea.Daniel J. Cho - Rheovector LLC, King of Prussia, PA, USA.Young I. Cho - Drexel University
- Publication Details
- Clinical hemorheology and microcirculation, v 67(2)
- Publisher
- Ios Press
- Number of pages
- 12
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Mechanical Engineering and Mechanics
- Web of Science ID
- WOS:000415733700008
- Scopus ID
- 2-s2.0-85034634882
- Other Identifier
- 991019167656304721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Hematology
- Peripheral Vascular Disease