THE COMBINED ISOVOLEMIC AND HYPERVOLEMIC HEMODILUTION IN PATIENTS WITH PERIPHERAL ARTERIAL OCCLUSIVE DISEASE IIB-IV ACCORDING TO FONTAINE

The aim of our study was to investigate the influence of different pla sma volume expanders on the results of the combined iso- and hypervole mic hemodilution therapy in 26 patients (aged 53.8 +/- 13.6 years) wit h peripheral arterial occlusive disease (IIb-IV according to Fontaine) . Tn a not placebo-controlled study, three groups of our patients unde rwent bloodlettings until a hematocrit between 30 and 35% was reached. Subsequently they received either a daily infusion of 500 ml of a 10% solution of dextrane 40, a 3.5% solution of hydrolyzed gelatine or bo th (changing every other day) for a total of 14 infusions. The effect of treatment was checked by clinical parameters and by measurement of plasma viscosity (Ubbelohde capillarviscosimetry) as well as hematocri t, erythrocyte aggregability (according to the method of Schmid-Schonb ein) and erythrocyte filtrability (according to the method of Teitel). These parameters were studied at the beginning and at the end of trea tment and after a follow-up of 4 weeks. A significant response to ther apy was observed in 58% of all patients, which after treatment could b e assigned to a less severe stage of disease according to Fontaine. Ot her patients showed at least a tendency to clinical improvement. The l owering of the hematocrit did not cause any severe side effects. Patie nts receiving gelatine solution displayed an increase of both the rela tive and the maximum walking distance, whereas patients treated with d extrane 40 did not. Patients who received both substances showed a sli ght increase of the walking distance. Significantly, the infusion of d extrane 40 solution caused a marked increase of both plasma viscosity and erythrocyte aggregability. In contrast, the application of gelatin e solution did not alter plasma viscosity but increased erythrocyte ag gregability, too. Erythrocyte filtrability did not change in any of th e three groups during the observation period. Taken together, our resu lts do neither favour one of the substances tested nor the combination of both. However, the encouraging results of combined iso- and hyperv olemic hemodilution therapy in general justify further application of this therapeutic approach.