First experiences with the heparin-induced extracorporeal low-density lipoprotein precipitation in the treatment of critical limb ischaemia: a new therapeutical approach?

The heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP) system is based on the fact that besides lipoproteins even fibrinogen, which seems to be a very important factor in pathogenesis of peripheral arterial disease, is precipitated by high-dose heparin at acid pH values. The elimination of excess fibrinogen and lipoproteins, in particular LDL, leads to a markedly improved microcirculation. The restoration of the latter obviously enabled us to perform limb-saving surgical procedures instead of mutilating amputations. 12 patients suffering from peripheral arterial disease were submitted to 18 HELP treatments in each case instead of having their critically ischaemic legs removed. Surgery could be limited to necrosectomy only and the wounds were either primarily sutured or covered with skin grafts. We were able to avoid 13 amputations in these 12 patients who could finally walk out of the hospital. HELP treatment was free of side effects in all of them.