Successful Treatment of Refractory Bilateral Leg Ulcers With an Adsorptive Blood-Purification Device.

Chronic limb-threatening ischemia (CLTI) is the most advanced stage of lower extremity artery disease. Patients with CLTI are often unsuitable for revascularization and thus have limited treatment options. In 2020, Japan approved Rheocarna for such cases. Rheocarna is an adsorptive blood-purification device that removes low-density lipoprotein cholesterol and fibrinogen. We presented the case of a 63-year-old man with chronic kidney disease and diabetes mellitus who presented with severe and progressing refractory ulcers. Angiography revealed severe arterial calcification, indicating CLTI. No targets for standard revascularization treatment were found. Together with wound care and hyperbaric oxygen, 20 Rheocarna treatment sessions improved circulation and ulcer healing, thus avoiding amputation. Thus, Rheocarna may be a promising therapy for CLTI patients who are ineligible for revascularization. Further studies are needed to validate its efficacy.