THE EFFECT OF HEMODILUTION UPON PATIENTS WITH INTERMITTENT CLAUDICATION

  • 1 January 1985
    • journal article
    • research article
    • Vol. 160  (4) , 347-351
Abstract
Seventeen patients with stable intermittent claudication and a PCV [packed cell volume] of more than 0.45 were venesected until a PCV of 0.35 was achieved. Only patients that were not considered candidates for surgical treatment were entered into the study. Each patient acted as their own control and was studied twice before the venesection at a mean PCV of 0.49 then after achieving a PCV of 0.35 or less (mean PCV of 0.33) and finally 1 m. after the last venesection (mean PCV of 0.37). Angina developed in 1 patient after the 3rd venesection and was withdrawn from the study. In the remaining 16 patients, blood flow of the calf muscle during exercise increased significantly after venesection from 5.90-8.84 mm/100 g/min (P = 0.02). This was measured by Xe 133 clearance and a Cd telluride detector. There was also a substantial decrease (P < 0.001) in whole blood viscosity at both low and high shear stresses, but there was no change in plasma viscosity or plasma fibrinogen. Treadmill claudication distance improved in 2 patients: 10 patients were tired when the PCV decreased to 0.35 and subjective claudication distanced deteriorated in 4 of these patients. Subsequent isovolemic venesection with dextran 70 volume replacement to a PCV of 0.35 did not improve the response in 6 patients restudied. Venesection did not benefit these patients with intermittent claudication; there was an unacceptable incidence of side effects. Reducing the PCV to 0.35 should be avoided in patients with intermittent claudication who were refused surgical treatment.