Effective LDL Apheresis in a Case of Peripheral Circulatory Insufficiency in the Forearm from Repeated Internal Arteriovenous Fistula Surgeries :

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  • Hara,Taiga
    Second Department of Internal Medicine, Faculty of Medicine, Kagawa University
  • Kiyomoto,Hideyasu
    Second Department of Internal Medicine, Faculty of Medicine, Kagawa University
  • Moriwaki,Kumiko
    Second Department of Internal Medicine, Faculty of Medicine, Kagawa University
  • Higashiyama,Chikako
    Hemodialysis Unit, Kagawa University Hospital
  • Matsubara,Keisuke
    Second Department of Internal Medicine, Faculty of Medicine, Kagawa University
  • Hitomi,Hirofumi
    Second Department of Internal Medicine, Faculty of Medicine, Kagawa University
  • Kondo,Naoki
    Second Department of Internal Medicine, Faculty of Medicine, Kagawa University
  • Kaifu,Kumiko
    Second Department of Internal Medicine, Faculty of Medicine, Kagawa University
  • Ihara,Genei
    Second Department of Internal Medicine, Faculty of Medicine, Kagawa University
  • Ohmori,Koji
    Second Department of Internal Medicine, Faculty of Medicine, Kagawa University
  • Kohno,Masakazu
    Second Department of Internal Medicine, Faculty of Medicine, Kagawa University

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Abstract

The patient was a female in her late 40's. She was initiated on hemodialysis treatment six years ago. She has undergone restorative surgeries (a total of 15) due to internal fistula problems. Since three years ago, she had experienced, in her right hand fingertips, numbness, pain at rest, and cyanosis during winter. Any medications such as vasodilating prostaglandin and anticoagulant had not improved her symptoms. We diagnosed the case as a peripheral circulatory insufficiency from radial artery occlusion due to repeated surgeries for internal fistula. Hemodialysis was performed 3 times per week without changes in her prescription. We treated her once a week with LDL-A-one course (10 sessions). Immediately after the start of the LDL-A therapy, the patient felt warmth in the peripheries of the extremities and had improvement in her subjective symptoms. After one course of treatment, we performed another angiography on the right upper extremity and observed a clear improvement in its peripheral blood flow and development of collateral circulatory pathways. LDL-A was an effective treatment for peripheral circulatory insufficiency in the forearm and palm physically caused by the internal fistula surgeries. LDL-A could become an adjuvant treatment for internal fistula problems in HD cases.

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