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LDL‐apheresis up‐regulates VEGF and IGF‐I in patients with ischemic limb

Although it is known that LDL‐apheresis improves ischemic limb seen in patients with peripheral arterial occlusive disease (PAOD), the underlying mechanism(s) still remains unknown. We studied whether vascular endothelial growth factor (VEGF) and/or insulin‐like growth factor‐I (IGF‐I) levels correlated with improvement of ischemic limbs after LDL‐apheresis. Sixteen patients with PAOD (13 men, 3 women) were enrolled in our study. LDL‐apheresis was performed 10 times (treated plasma 3,000 ml) for 5 weeks. Serum level of VEGF significantly increased from 262 ± 171 pg/ml to 306 ± 165 pg/ml before and after LDL‐apheresis (P < 0.05). This value further increased up to 441 ± 175 pg/ml 3 months after the end of this therapy (P < 0.01, compared with the basal value and P < 0.05, compared with the value at the end of 10‐times session). Increased levels of VEGF paralleled increases in the ankle‐brachial pressure index (ABI). After 10‐times therapy, IGF‐I significantly decreased (P < 0.05), but increased over the basal value 3 months after this therapy. Plasma fibrinogen statistically decreased and remained low for 3 months. The favorable effects of LDL‐apheresis may be ascribed to up‐regulation of VEGF and IGF‐I associated with decreased fibrinogen levels. J. Clin. Apheresis, 18:115–119, 2003. © 2003 Wiley‐Liss, Inc.