# The Effectiveness of Low-Density Lipoprotein/Fibrinogen Apheresis in Promoting Wound Healing of No-Option Chronic Limb-Threatening Ischemia Foot Ulcers with Wound, Ischemia, and Foot Infection (WIfI) Wound Grade 3: A Single-Center Retrospective Analysis

## TL;DR

This study shows that apheresis therapy can help heal severe foot ulcers in patients with advanced limb ischemia who have no other treatment options.

## Contribution

The study demonstrates the effectiveness of low-density lipoprotein/fibrinogen apheresis in treating no-option CLTI foot ulcers.

## Key findings

- 78.1% of CLTI ulcers treated with apheresis had excellent or good outcomes.
- 75% of patients achieved wound healing without major amputation.
- Skin perfusion pressure above 28.5 mmHg predicted successful outcomes.

## Abstract

Background: Chronic limb-threatening ischemia (CLTI) is a severe condition associated with high mortality and amputation rates, particularly in patients with diabetes, renal failure, or severe vascular disease. In cases where revascularization fails or is not possible, adjunctive therapies can improve the treatment outcomes. Therefore, this single-center retrospective study aimed to evaluate the effectiveness of low-density lipoprotein/fibrinogen apheresis (Rheocarna®) in promoting wound healing in patients with no-option CLTI, focusing on large wounds. Methods: We examined the data of 32 CLTI ulcers treated with Rheocarna® from 2021 to 2024. Results: The outcomes in 25 cases (78.1%) were rated as excellent or good, and the outcomes of 11 (73.3%) wound, ischemia, and foot infection (WIfI) wound-3 ulcers were excellent or good. Overall, 75% of the CLTI ulcers achieved wound healing without major amputation. Predictive factors for successful wound healing included age, baseline skin perfusion pressure, and wound grade (WIfI classification). A skin perfusion pressure threshold of 28.5 mmHg (WIfI ischemic grade 3) was a significant predictor of positive outcomes. Conclusions: Our results support the use of Rheocarna® as a viable adjunctive therapy in managing refractory large ischemic ulcers and preventing major amputations.