Lipid apheresis is a specialized medical procedure that removes excess lipids, such as cholesterol, directly from the bloodstream. This non-pharmacological treatment is used when conventional therapies are insufficient to manage severe lipid disorders. It is considered for individuals who struggle to control their lipid levels through diet, exercise, and medication alone.
Understanding Lipid Apheresis and Its Purpose
Lipid apheresis circulates a patient’s blood outside the body, similar to kidney dialysis, to selectively remove specific lipid particles. The process separates blood components, isolates the plasma containing harmful lipids, and then returns the treated blood to the patient. This method directly reduces concentrations of low-density lipoprotein (LDL) cholesterol and lipoprotein(a) (Lp(a)), which are linked to atherosclerosis.
The procedure’s purpose is to rapidly and substantially lower these lipid levels, which can be difficult to achieve with medications alone in severe conditions. This mitigates the progression of cardiovascular disease and reduces the risk of events like heart attacks or strokes.
Who Undergoes Lipid Apheresis?
Individuals considered for lipid apheresis have severe lipid disorders that do not respond adequately to maximum tolerated doses of cholesterol-lowering medications, such as statins. One common indication is severe familial hypercholesterolemia (FH), an inherited condition with exceptionally high LDL cholesterol levels from birth. These patients often have genetic mutations that impair their body’s ability to clear LDL cholesterol, leading to premature and aggressive cardiovascular disease.
Another group includes patients with very high levels of lipoprotein(a) (Lp(a)), an independent risk factor for cardiovascular disease and aortic valve stenosis, especially when other risk factors are present. Standard lipid-lowering drugs often have limited impact on Lp(a) levels for these individuals. Lipid apheresis is also considered for patients who have already experienced cardiovascular events despite aggressive conventional treatment, indicating a persistent high risk. Patient selection involves a thorough evaluation by specialists to confirm the diagnosis, assess cardiovascular risk, and ensure other treatment options have been exhausted.
The Procedure: How It Works and What to Expect
The lipid apheresis procedure begins with establishing vascular access, often by inserting two needles, one in each arm, to allow blood flow to and from the apheresis machine. If peripheral veins are not suitable, a central venous catheter may be placed. The patient’s blood is continuously drawn from one arm and directed into the apheresis device, which is designed to separate plasma from blood cells.
Within the machine, the plasma, containing harmful lipids, passes through a specialized filter or column that selectively binds and removes LDL cholesterol and Lp(a). The treated plasma is then recombined with the patient’s blood cells, and the filtered blood is returned to the patient’s other arm.
A single treatment session usually lasts two to four hours, depending on the patient’s blood volume and the specific apheresis system used. During the procedure, patients sit or recline comfortably. Medical staff closely monitor vital signs and the machine’s operation. After the treatment, needles are removed, and pressure is applied to the access sites to prevent bruising. Patients can usually resume normal activities shortly thereafter, though some may experience mild fatigue.
Effectiveness and Potential Considerations
Lipid apheresis is effective in acutely reducing LDL cholesterol and Lp(a) levels, often by 60% to 80% per session. Treatment frequency varies, ranging from weekly to bi-weekly sessions, to maintain lipid levels within a desired range. Regular treatments slow the progression of atherosclerosis and reduce the incidence of cardiovascular events in patients with severe, otherwise untreatable hyperlipidemia.
While considered safe, some side effects can occur during or after the procedure, though these are mild and temporary. Common side effects include a transient drop in blood pressure, dizziness, nausea, or localized discomfort at the needle insertion sites. Minor allergic reactions to components used in the procedure are also possible but rare. Experienced medical professionals manage these effects by adjusting flow rates or providing supportive care. The benefits of significant lipid reduction for high-risk patients outweigh these manageable considerations, making lipid apheresis a therapeutic option.