Lipid apheresis and rheopheresis for treatment of peripheral arterial disease

Lipid apheresis is an effective lipid-lowering treatment in drug unresponsive severely hypercholesterolemic patients with coronary artery disease. It results in symptomatic improvement, reduces progression of coronary atherosclerosis, and decreases coronary event rates. These effects are partly caused by aggressive lipid lowering itself and partly by unselective removal of high molecular weight proteins leading to improved hemorheology. This review summarizes current available data on the proposed mechanisms by which lipid apheresis acts anti-atherosclerotic and improves ischemic symptoms. Based on this, it discusses the putative effects of lipid apheresis on restoring patho-physiological processes involved in the development of symptoms of peripheral arterial disease and critical limb ischemia. The available clinical experience with lipid apheresis and rheopheresis in treating patients with peripheral arterial disease is then critically reviewed and put into the context of currently available treatment options.