The initial
element in the causation of venous ulceration is a disturbance of venous blood flow that leads to an increase in venous pressure. Eventually, however, it is the microcirculatory consequences of venous
hypertension that lead to trophic skin changes and finally to ulceration. A reduction in blood viscosity results in an improvement at the microcirculatory level. The elimination of
fibrinogen from plasma improves blood viscosity. This case report concerns a 75-year-old woman with
venous ulcers of both legs (left lower leg: deep ulceration with a surface area of 3 x 5 cm; right lower leg: superficial, confluent ulceration with a total surface area of 5 x 10 cm). The patient underwent 20 sessions of
fibrinogen adsorption, while simultaneously continuing with a regimen of conservative measures (
activated charcoal cloth dressing with
silver,
calcium alginate dressings and short-stretch
compression bandages). Following binding to a
peptide (
Gly-Pro-Arg-Pro-Lys),
fibrinogen and
fibrin were specifically removed from the patient's plasma: her
fibrinogen concentration was lowered from an original mean level of 310 mg/dl (SD +/- 104 mg/dl) to 136 mg/dl (SD +/- 54 mg/dl), and there was no return to the baseline concentration by the time of the next
fibrinogen adsorption session. In response to this treatment the patient's
ulcers healed rapidly within 9 weeks.
Dizziness and
hematomas at the vascular access sites in both antecubital fossae were reported as adverse effects. A fall in hematocrit was also noted (before treatment 37% +/- 1%;
after treatment 35% +/- 2%). This may have been caused by
hemodilution due to the procedure and to cell losses during blood-plasma separation, a phenomenon that is known to occur during
apheresis. This case report suggests that
fibrinogen adsorption is low in adverse effects and is a useful addition to the range of treatments available for
ulcers of venous etiology.