Lipoprotein apheresis is an optimal therapeutic option to reduce increased Lp(a) levels

Background and Aim: Elevated low-density lipoprotein cholesterol and/or lipoprotein(a) are established risk factors for cardiovascular disease (CVD). Management of hypercholesterolemia consists of drug therapies, including statins and proprotein convertase subtilisin/kexin type 9 inhibitors. In patients with familial hypercholesterolemia (FH), lipoprotein apheresis (LA) is utilized to control lipid levels. However, LA is not currently a standard therapy for non-FH. This review summarizes the literature regarding LA therapy in CVD prevention. Methods: PubMed/MEDLINE databases were searched using the keywords “LA” and “CVD”. Citations were individually reviewed for relevance. Results: The efficacy of LA was clearly demonstrated, largely based on evidence from observational studies. In patients who are unresponsive to traditional lipid-lowering medications, LA effectively reduced serum lipoprotein levels and adverse cardiovascular events. Conclusion: It was concluded that LA is a safe and effective technique that could be considered in the management of hypercholesterolemia and future risk. Randomized control trials would further support a role for LA as a therapeutic option.

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Desialylation of platelet surface glycans enhances platelet adhesion to adsorbent polymers for lipoprotein apheresis

The International Journal of Artificial Organs ◽

10.1177/0391398820968849 ◽

2020 ◽

pp. 039139882096884

Author(s):

Lucia Lauková ◽

René Weiss ◽

Vladislav Semak ◽

Viktoria Weber

Keyword(s):

Whole Blood ◽

Platelet Adhesion ◽

Therapeutic Option ◽

Platelet Factor ◽

Platelet Surface ◽

Platelet Counts ◽

Lipoprotein Apheresis ◽

Elevated Expression ◽

Flow Through

Background: Lipoprotein apheresis is an important therapeutic option in homozygous familial hypercholesterolemia, progressive atherosclerosis, or when depletion of lipoprotein(a) is indicated. It is generally regarded as safe, but drops in platelet counts as well as sporadic episodes of thrombocytopenia have been reported. We assessed the influence of platelet desialylation, which may be induced by endogenous or pathogen-derived neuraminidases, on platelet adhesion to polyacrylate-based adsorbents for whole blood lipoprotein apheresis. Methods: Medical grade platelet concentrates were incubated with neuraminidase in vitro and were circulated over adsorbent columns downscaled from clinical application. Results: Cleavage of terminal sialic residues resulted in platelet activation with significantly elevated expression of platelet factor 4 (PF4) and in enhanced platelet adhesion to the adsorbent, accompanied by a pronounced drop in platelet counts in the column flow-through. Conclusion: Alterations in endogenous neuraminidase activity or exogenous (pathogen-derived) neuraminidase may trigger enhanced platelet adhesion in whole blood lipoprotein apheresis.

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COVID-19 complicated by pulmonary embolism treated with catheter directed thrombectomy

VASA ◽

10.1024/0301-1526/a000880 ◽

2020 ◽

Vol 49 (4) ◽

pp. 333-337 ◽

Cited By ~ 3

Author(s):

Francisco Leonardo Galastri ◽

Leonardo Guedes Moreira Valle ◽

Breno Boueri Affonso ◽

Marcela Juliano Silva ◽

Rodrigo Gobbo Garcia ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Dynamic Process ◽

Therapeutic Option ◽

Massive Pulmonary Embolism ◽

Percutaneous Intervention ◽

Thromboembolic Events ◽

Emergency Center ◽

Catheter Directed Thrombolysis

Summary: COVID-19 is a recently identified illness that is associated with thromboembolic events. We report a case of pulmonary embolism in a patient with COVID-19, treated by catheter directed thrombectomy. A 57 year old patient presented to the emergency center with severe COVID-19 symptoms and developed massive pulmonary embolism. The patient was treated with catheter directed thrombolysis (CDT) and recovered completely. Coagulopathy associated with COVID-19 is present in all severe cases and is a dynamic process. We describe a case of massive/high risk pulmonary embolism, in a patient with COVID-19 receiving full anticoagulation, who was treated by percutaneous intervention. CDT can be an additional therapeutic option in patients with COVID-19 and pulmonary embolism that present with rapid clinical collapse.

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Endovascular repair of a spontaneous ilio-iliac fistula presenting as pulmonary embolism

VASA ◽

10.1024/0301-1526/a000100 ◽

2011 ◽

Vol 40 (3) ◽

pp. 246-250 ◽

Cited By ~ 4

Author(s):

Melas ◽

Saratzis ◽

Abbas ◽

Sarris ◽

Saratzis ◽

...

Keyword(s):

Pulmonary Embolism ◽

Endovascular Repair ◽

Therapeutic Option ◽

Artery Aneurysm ◽

Iliac Vein ◽

Massive Pulmonary Embolism ◽

Long Term Results ◽

Common Iliac Vein ◽

Iliac Artery Aneurysm ◽

Common Iliac Artery Aneurysm

Spontaneous rupture of a common iliac artery aneurysm into the common iliac vein is a rare phenomenon. We report the case of a 68 year old man admitted with acute cardiac failure and massive pulmonary embolism as a complication of a spontaneous ilio-iliac fistula, secondary to aneurysmal rupture. The aneurysm was successfully excluded using an aorto-uni-iliac stent graft. No complications were noted at 9 months follow-up. Arteriovenous fistulae should be considered in patients with aortic or iliac aneurysms who develop a pulmonary embolism or symptoms of venous congestion. Endovascular repair of these pathologies is a feasible therapeutic option; however long term results remain unknown.

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Auricular vagal nerve stimulation in peripheral arterial disease patients

VASA ◽

10.1024/0301-1526/a000660 ◽

2017 ◽

Vol 46 (6) ◽

pp. 462-470 ◽

Cited By ~ 3

Author(s):

Gerald Hackl ◽

Andreas Prenner ◽

Philipp Jud ◽

Franz Hafner ◽

Peter Rief ◽

...

Keyword(s):

Primary Endpoint ◽

Nerve Stimulation ◽

Short Form ◽

Therapeutic Option ◽

Arterial Disease ◽

Walking Distance ◽

Control Group ◽

Sf 36 ◽

Peripheral Arterial ◽

Double Blinded

Abstract. Background: Auricular nerve stimulation has been proven effective in different diseases. We investigated if a conservative therapeutic alternative for claudication in peripheral arterial occlusive disease (PAD) via electroacupuncture of the outer ear can be established. Patients and methods: In this prospective, double-blinded trial an ear acupuncture using an electroacupuncture device was carried out in 40 PAD patients in Fontaine stage IIb. Twenty patients were randomized to the verum group using a fully functional electroacupuncture device, the other 20 patients received a sham device (control group). Per patient, eight cycles (1 cycle = 1 week) of electroacupuncture were performed. The primary endpoint was defined as a significantly more frequent doubling of the absolute walking distance after eight cycles in the verum group compared to controls in a standardized treadmill testing. Secondary endpoints were a significant improvement of the total score of the Walking Impairment Questionnaire (WIQ) as well as improvements in health related quality of life using the Short Form 36 Health Survey (SF-36). Results: There were no differences in baseline characteristics between the two groups. The initial walking distance significantly increased in both groups (verum group [means]: 182 [95 % CI 128–236] meters to 345 [95 % CI 227–463] meters [+ 90 %], p < 0.01; control group [means]: 159 [95 % CI 109–210] meters to 268 [95 % CI 182–366] meters [+ 69 %], p = 0.01). Twelve patients (60 %) in the verum group and five patients (25 %) in controls reached the primary endpoint of doubling walking distance (p = 0.05). The total score of WIQ significantly improved in the verum group (+ 22 %, p = 0.01) but not in controls (+ 8 %, p = 0.56). SF-36 showed significantly improvements in six out of eight categories in the verum group and only in one of eight in controls. Conclusions: Electroacupuncture of the outer ear seems to be an easy-to-use therapeutic option in an age of increasingly invasive and mechanically complex treatments for PAD patients.

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Adult-to-Adult Living-Donor Liver Transplantation

Swiss Surgery ◽

10.1024/1023-9332.9.5.227 ◽

2003 ◽

Vol 9 (5) ◽

pp. 227-236 ◽

Cited By ~ 3

Author(s):

Majno ◽

Mentha ◽

Berney ◽

Bühler ◽

Giostra ◽

...

Keyword(s):

Liver Transplantation ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Therapeutic Option ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Multidisciplinary Program ◽

First Case ◽

Living Donor Transplantation ◽

The Right

Living donor liver transplantation is a relatively new procedure in which the right side of the liver is harvested in a healthy donor and transplanted into a recipient. After the first case in 1994, over 3000 cases have been done worldwide. This review summarizes the reasons why the procedure is needed, describes its main technical aspects, highlights the boundaries in which it can be done safely, summarizes the current experience worldwide and describes the main points of the program in our unit. We argue that living-donor transplantation is a viable alternative to a long time on the waiting list for several patients, and it can be performed safely and successfully provided that all precautions are undertaken to minimize the risks in the donor and to increase the chances of a good outcome in the recipients. If these prerequisites are met, and within the framework of a structured multidisciplinary program, we believe that living-donor liver transplantation should be funded by health insurances as a recognized therapeutic option.

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