Korean J Med.  1998 Nov;55(5):971-976.

Report of a case: A case of medically resistant diabetic gangrene of foot which is healed by HELP (Heparin-mediated extracorporeal low density-lipoprotein cholesterol fibrinogen precipitation) therapy

• Yoon YS
• Chung KH
• Lee SR
• Choi SH
• Shim WH
• Jang Y

Abstract

HELP (Heparin-mediated extracorporeal low-density lipoprotein fibrinogen precipitation) is an LDL apheresis system which has been utilized as a last therapeutic option for drug resistant hypercholesterolemia. Recently the scope of the treatment has been expanded to coronary artery obstructive disease (CAOD) or peripheral arterial obstructive disease (PAOD) with dyslipidemia. We applied six sessions of HELP therapy with a week interval to a patient with diabetic gangrene of both feet and PAOD who had elevated LDL-cholesterol and fibrinogen despite maximal drug therapy. Lipids, Lp (a) and fibrinogen were measured on plasma samples before and after treatment. Changes of symptoms and physical findings were reported before, immediately after and 3 month after treatment. In every session, LDL cholesterol level was reduced more than 40%. Mean LDL cholesterols were reduced from 133.5 mg/dL to 55.0 mg/dL (59%). Total cholesterol (104.5 mg/dL;51% decrease), triglycerides (142.0 mg/dL;47% decrease) and Lp (a) (24.3 mg/dL; 58% decrease) levels were also reduced. Mean HDL cholesterol was reduced to 6.3 mg/dL (25%) with prompt recovery to pretreatment level within one week. Mean fibrinogen decreased from 571.0 mg/dL to 253.3 mg/dL (58%) without bleeding complications. Two episodes of dizziness with spontaneous resolution were observed during or over three days after treatment. Two sessions of HELP made diabetic gangrene on toes improved. After six sessions, the gangrenes showed near-complete healing. So we report a case of a patient who had persistent diabetic gangrene of both feet despite proper revascularization, which was completely healed by HELP without significant side effects.

Keyword

HELP; LDL apheresis; Diabetes; Gangrene

MeSH Terms

Arterial Occlusive Diseases
Blood Component Removal
Cholesterol*
Cholesterol, HDL
Cholesterol, LDL
Coronary Vessels
Dizziness
Drug Therapy
Dyslipidemias
Fibrinogen*
Foot*
Gangrene*
Hemorrhage
Humans
Hypercholesterolemia
Lipoproteins
Plasma
Toes
Triglycerides
Cholesterol
Cholesterol, HDL
Cholesterol, LDL
Fibrinogen
Lipoproteins
Triglycerides